Abstract
BackgroundPatients with chronic kidney disease (CKD) due to glomerulonephritis (GN) are thought to be at high risk for cardiovascular disease (CVD). However, no study has examined whether GN directly contributes to CV risk beyond the effects conferred by pre-existing traditional risk factors and level of renal function.MethodsMatched cohort study using the previously described prospective CanPREDDICT study cohort. 2187 patients with CKD (eGFR 15–45 ml/min/m2) from 25 Canadian centres were divided into GN vs non-GN cause of CKD. Patients on immunotherapy for GN were not included in the study. Standardized measures of CV risk factors, biomarkers and CV outcomes were recorded over 3 years of follow-up, with the primary outcome measure being time to first all-cause CV event.ResultsIn the overall cohort, CV events occurred in 25 (8.7%) of the GN group and 338 (17.8%) of the non-GN group (HR 0.45, 95% CI 0.30–0.67, p < 0.01). In a Cox regression multivariable model that included age, sex, prior diabetes and CVD, baseline eGFR and onset of renal replacement therapy, the risk of CV events was similar in the GN and non-GN groups (HR 0.71, 95% CI 0.47–1.08, p = 0.11). GN and non-GN patients were matched by age and using a propensity score including sex, prior diabetes and CVD and baseline eGFR. In the matched group, the risk of CV events was similar in GN vs non-GN patients (N = 25/271 (9.2%) in both groups, HR 1.01, 95% CI 0.05–1.77, p = 0.9). An interaction analysis showed that CRP, ACR and troponin conferred differing amounts of CV risk in the GN and non-GN groups.ConclusionsPatients with advanced CKD due to GN have a high 8.7% absolute 3-year risk of CVD, attributable to prior CV risk factors and level of kidney function rather than the GN disease itself.
Highlights
Patients with chronic kidney disease (CKD) due to glomerulonephritis (GN) are thought to be at high risk for cardiovascular disease (CVD)
Because novel CV risk factors are proposed to be uniquely important in glomerular diseases [7, 13, 14], we explored whether the association between CVD risk and proteinuria or biomarkers of inflammation and endothelial dysfunction is different in patients with GN compared to non-GN CKD
Biomarkers as CV risk factors in GN compared to matched non-GN CKD patients Using the matched cohort, we explored whether the risk of CVD associated with ACR, Creactive protein (CRP), IL-6, asymmetric dimethylarginine (ADMA), troponin I and pro-brain natriuretic peptide (ProBNP) was different in the GN compared to non-GN groups using interaction terms
Summary
Patients with chronic kidney disease (CKD) due to glomerulonephritis (GN) are thought to be at high risk for cardiovascular disease (CVD). Patients with glomerulonephritis (GN) have been traditionally characterised as being at high risk of cardiovascular disease (CVD), and this has been recently reiterated in the 2012 KDIGO GN guidelines [1]. We used the CanPREDDICT cohort to examine our primary hypothesis that the risk of CVD over 3 years in patients with GN is higher compared to those with non-GN causes of CKD, after accounting for traditional CVD risk factors and renal function. Because novel CV risk factors are proposed to be uniquely important in glomerular diseases [7, 13, 14], we explored whether the association between CVD risk and proteinuria or biomarkers of inflammation and endothelial dysfunction is different in patients with GN compared to non-GN CKD
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