Abstract P061: Incidence of Major Cardiovascular Disease and Subsequent Risk of End-stage Renal Disease: the Atherosclerosis Risk in Communities (ARIC) Study

Abstract

Background: Cardiorenal syndrome is a well-known concept. However, in contrast to extensive investigations of chronic kidney disease (CKD) as a risk factor of cardiovascular disease (CVD), whether CVD increases long-term risk of end-stage renal disease (ESRD) is much less studied. Methods: In 8,881 participants of the Atherosclerosis Risk in Communities Study who attended visit 4 (1996-1998), we assessed the association of incident hospitalization with major CVD (heart failure, atrial fibrillation, coronary heart disease, and stroke) with subsequent risk of ESRD. Hospitalization with CVD was entered into multivariable Cox models as a time-varying exposure to estimate hazard ratios (HRs) and 95% confidence intervals (CI). Results: Baseline mean age was 62 years, 59% were female, 22% were black, and 5.5% had eGFR 15-60 ml/min/1.73m 2 . During a median follow-up of 15.9 years, there were 141 cases of ESRD. In multivariable Cox analysis, each incident CVD subtype was independently associated with increased risk of ESRD, with the highest HR for heart failure (HR, 16.9 [95%CI, 11.6-24.7]), followed by coronary heart disease, atrial fibrillation, and stroke (Model 2 in Table ). The association remained significant across CVD subtypes except for atrial fibrillation, when all CVD subtypes were simultaneously entered into a Cox model as time-varying exposures (Model 3 in Table ). The results were similar when modeling death as a competing risk, and consistent across subgroups of age, sex, race, diabetes, and CKD. When analyzing confirmed events of heart failure with preserved ejection fraction (HFpEF) (n=205) and reduced ejection fraction (HFrEF) (n=190), the association was particularly evident for HFpEF (10.8 [5.9-19.7]) compared to HFrEF (4.9 [2.0-11.7]). Conclusions: These findings support CVD as a potent risk factor of ESRD. Patients with CVD, particularly heart failure, should be recognized as a high risk population for ESRD. Distinct contribution of HFpEF vs. HFrEF to ESRD deserves future investigations.