Cardiovascular risk factors and the impact on prognosis in patients with chronic kidney disease secondary to autosomal dominant polycystic kidney disease

José Luis Gorriz,Vicente Pallares-Carratalá,David Arroyo,Marco Montomoli,Nayara Panizo,Roser Torra,José Luis Llisterri,Patricia Tomás,Luis D’Marco,José Manuel Valdivielso,Jonay Pantoja,María Jesús Puchades

doi:10.1186/s12882-021-02313-1

Abstract

BackgroundAutosomal dominant polycystic kidney disease (ADPKD) is the most frequent hereditary renal disease. There is an increased rate of cardiovascular disease (CVD) in ADPKD. In this study, we evaluate the prevalence of cardiovascular risk factors, the achievement rates for treatment goals and cardiovascular events (CVE) in ADPKD and their relations with asymptomatic CVD in CKD from other etiologies (CKDoe) and controls.MethodsWe evaluated 2445 CKD patients (2010–2012). The information collected was: clinical, anthropometric and analytical parameters, treatments and CVD evaluation (intima-media thickness (IMT), atheromatous plaque presence and ankle-brachial index (ABI)). Laboratory, vital status, CVE and hospitalizations were collected for 4 years.ResultsADPKD patients had a worse renal function and worst achievement of blood pressure, higher parathormone levels but lower proteinuria compared to CKDoe. ADPKD patients presented lower IMT values than other groups, however, an intermediate rate of pathologic ABI and atheromatous plaque was present. More than half of the patients received statins, achieving LDL-c levels < 100 only in 50 and 39.8% of them (ADPKD and CKDoe respectively). The number of CVE during the follow-up period was low. In adjusted Cox regression model, ADPDK had the lowest occurrence of CVE of all three groups (HR:0.422, 95%CI 0.221–0.808, p = 0.009).ConclusionADPKD patients show intermediate control rates of CVD. A better control of CVD risk seems to be related with a lower load of CVD compared to other groups, which may lead in the long term to a better prognosis. Further investigation is necessary to determine cardiovascular prognosis in ADPKD.

Highlights

Cardiovascular disease (CVD) is the leading cause of death in patients with chronic kidney disease (CKD) from earlier stages of the disease compared to the general population [1, 2]
This study evaluates the prevalence of classic cardiovascular risk factors in Autosomal dominant polycystic kidney disease (ADPKD), its relationships to asymptomatic cardiovascular disease (CVD) and treatment trends in ADPKD patients in a large cohort of CKD patients and controls without previous CVD
Study design and participants This study is a sub-analysis of the NEFRONA project, which consists of a large prospective multicenter cohort designed to evaluate asymptomatic CVD in patients at different stages of CKD without previous cardiovascular events (CVE)

Summary

Introduction

Cardiovascular disease (CVD) is the leading cause of death in patients with chronic kidney disease (CKD) from earlier stages of the disease compared to the general population [1, 2]. CKD has been considered an important cardiovascular risk factor in several international guidelines. CKD per se produces several alterations that have a direct impact on vascular health, such as proteinuria, anemia, metabolic acidosis or mineral bone disease (MBD). These lastly is known as non-traditional or uremic related factors. Some of these factors may partially explain the higher rates of both asymptomatic CVD and cardiovascular events (CVE) among CKD patients. We evaluate the prevalence of cardiovascular risk factors, the achievement rates for treatment goals and cardiovascular events (CVE) in ADPKD and their relations with asymptomatic CVD in CKD from other etiologies (CKDoe) and controls

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Results

Conclusion