Risk factors for recurrent cardiovascular events in CKD: results from the KNOW-CKD study

Area of Science:

• Nephrology
• Cardiology
• Epidemiology

Background:

• Chronic kidney disease (CKD) significantly elevates cardiovascular (CV) risk.
• Recurrent CV events are common in CKD patients, potentially underestimating total CV burden if only first events are analyzed.

Purpose of the Study:

• To evaluate determinants of both first and recurrent non-fatal cardiovascular events in patients with chronic kidney disease.

Main Methods:

• Analysis of 2099 non-dialysis CKD participants from the prospective KNOW-CKD cohort.
• Adjudication of CV events including myocardial infarction, stroke, heart failure, revascularization, and arrhythmias.
• Utilized Cox proportional hazards, Andersen-Gill, Prentice-Williams-Peterson, and shared-frailty models to assess event predictors.

Main Results:

• Over 8.29 years median follow-up, 9.7% experienced non-fatal CV events, with some having multiple events.
• Baseline CV disease and diabetes were linked to higher cumulative CV event burdens.
• Older age, diabetes, prior CV disease, elevated C-reactive protein (CRP), albuminuria, and lower BMI predicted recurrent events, with CRP and albuminuria showing stronger recurrence associations.

Conclusions:

• Recurrent CV risk in CKD is influenced by traditional factors like diabetes, alongside vascular injury and inflammation markers.
• Targeting both metabolic and inflammatory pathways is crucial for mitigating the recurrent CV burden in CKD patients.