Renal function and cardiovascular events in predialysis care

Area of Science:

• Nephrology
• Cardiology
• Epidemiology

Background:

• Cardiovascular events (CVE) are a leading cause of morbidity and mortality in patients with chronic kidney disease (CKD).
• The association between renal function and CVE risk in advanced CKD (predialysis) remains unclear.
• Understanding these associations is crucial for developing effective preventive strategies.

Purpose of the Study:

• To evaluate the association between renal function and CVE in a prospective cohort of predialysis patients.
• To identify key risk factors for CVE in this high-risk population.
• To inform targeted interventions for reducing cardiovascular risk in advanced CKD.

Main Methods:

• Prospective observational study of 389 predialysis patients (GFR < 30 ml/min) between 2016-2022.
• Renal function assessed by measured (mGFR) and estimated (eGFR) glomerular filtration rate using multiple equations.
• Logistic regression models adjusted for traditional and CKD-specific risk factors were used to analyze associations with CVE.

Main Results:

• Over a median follow-up of 19 months, 30% of patients experienced CVE.
• Independent risk factors for CVE included older age, diabetes, smoking, and a history of prior CVE.
• Renal function (mGFR and eGFR), proteinuria, traditional CVE risk factors, and CKD-related factors were not significantly associated with CVE risk.

Conclusions:

• In predialysis CKD patients, established risk factors like age, diabetes, smoking, and prior CVE are the primary drivers of cardiovascular events.
• Renal function and proteinuria did not emerge as significant independent predictors of CVE in this cohort.
• Current guideline-based management may be effectively mitigating the impact of renal function on CVE risk, necessitating novel, targeted strategies to further reduce cardiovascular burden.