End-stage kidney disease in patients with clinically manifest vascular disease; incidence and risk factors: results from the UCC-SMART cohort study

Helena Bleken Østergaard,Folkert W Asselbergs,Jan Westerink,Frank L J Visseren,Marianne C Verhaar,Joep Van Der Leeuw,Gert J De Borst,L Jaap Kappelle,Michiel L Bots

doi:10.1007/s40620-021-00996-1

Abstract

BackgroundPatients with cardiovascular disease (CVD) are at increased risk of end-stage kidney disease (ESKD). Insights into the incidence and role of modifiable risk factors for end-stage kidney disease may provide means for prevention in patients with cardiovascular disease.MethodsWe included 8402 patients with stable cardiovascular disease. Incidence rates (IRs) for end-stage kidney disease were determined stratified according to vascular disease location. Cox proportional hazard models were used to assess the risk of end-stage kidney disease for the different determinants.ResultsSixty-five events were observed with a median follow-up of 8.6 years. The overall incidence rate of end-stage kidney disease was 0.9/1000 person-years. Patients with polyvascular disease had the highest incidence rate (1.8/1000 person-years). Smoking (Hazard ratio (HR) 1.87; 95% CI 1.10–3.19), type 2 diabetes (HR 1.81; 95% CI 1.05–3.14), higher systolic blood pressure (HR 1.37; 95% CI 1.24–1.52/10 mmHg), lower estimated glomerular filtration rate (eGFR) (HR 2.86; 95% CI 2.44–3.23/10 mL/min/1.73 m2) and higher urine albumin/creatinine ratio (uACR) (HR 1.19; 95% CI 1.15–1.23/10 mg/mmol) were independently associated with elevated risk of end-stage kidney disease. Body mass index (BMI), waist circumference, non-HDL-cholesterol and exercise were not independently associated with risk of end-stage kidney disease.ConclusionsIncidence of end-stage kidney disease in patients with cardiovascular disease varies according to vascular disease location. Several modifiable risk factors for end-stage kidney disease were identified in patients with cardiovascular disease. These findings highlight the potential of risk factor management in patients with manifest cardiovascular disease.Graphic abstract

Highlights

Chronic kidney disease (CKD) is a growing health problem worldwide, predicted to be the 5th most common cause of life-years lost by 2040 [1]
To the best of our knowledge, no previous study investigated the relation between modifiable risk factors for cardiovascular disease (CVD) and occurrence of end-stage kidney disease (ESKD) in a high-risk population cohort with different manifestations of CVD, including cerebrovascular disease, coronary artery disease (CAD), peripheral artery disease (PAD) or polyvascular disease
The present study shows that the incidence of ESKD in patients with stable manifest CVD varies according to vascular disease location

Summary

Introduction

Chronic kidney disease (CKD) is a growing health problem worldwide, predicted to be the 5th most common cause of life-years lost by 2040 [1]. CKD is irreversible and in most cases progressive, and the consequences include progression to end-stage kidney disease (ESKD), as well as an increased risk for cardiovascular disease (CVD) and mortality [3, 4]. Known modifiable risk factors for ESKD include hypertension [7, 8], T2DM [9, 10] kidney function [11], obesity [12], dyslipidemia [13], smoking [14,15,16] and exercise [17] These risk factors for ESKD are primarily investigated in low-risk populations and the effect of these risk factors may differ in patients with vascular disease, especially in more advanced cases. These findings highlight the potential of risk factor management in patients with manifest cardiovascular disease

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