Abstract

ObjectiveTo determine whether kidney function independently relates to endothelial activation and ultrasound determined carotid atherosclerosis in black and white Africans with rheumatoid arthritis (RA).MethodsWe calculated the Jelliffe, 5 Cockcroft-Gault equations, Salazar-Corcoran, Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimated glomerular filtration rate (EGFR) equations in 233 (112 black) RA patients.ResultsThe CKD-EPI eGFR was <90 ml/min/1.73m2 in 49.1% and 30.6% of black and white patients, respectively (odds ratio (95% confidence interval) = 2.19 (1.28–3.75), p = 0.004). EGFRs were overall consistently associated with monocyte chemoattractant protein-1 and angiopoietin 2 concentrations in white patients, and with carotid intima-media thickness and plaque in black participants. Amongst black patients, plaque prevalence was 36.7% and the area under the curve (AUC) of the receiver operating characteristic (ROC) curve was not associated with plaque presence for the MDRD equation (p = 0.3), whereas the respective relationship was significant or borderline significant (p = 0.003 to 0.08) and of similar extent (p>0.1 for comparisons of AUC (SE)) for the other 8 equations. Based on optimal eGFR cutoff values with sensitivities and specificities ranging from 42 to 60% and 70 to 91% respectively, as determined in ROC curve analysis, a low eGFR increased the odds ratio for plaque 2.2 to 4.0 fold.ConclusionReduced kidney function is independently associated with atherosclerosis and endothelial activation in black and white Africans with RA, respectively. CKD is highly prevalent in black Africans with RA. Apart from the MDRD, eGFR equations are useful in predicting carotid plaque presence, a coronary heart disease equivalent, amongst black African RA patients.

Highlights

  • In 1974, Lindner and colleagues [1] reported that atherosclerotic coronary heart disease (CHD) risk is increased in patients on dialysis

  • Plaque prevalence was 36.7% and the area under the curve (AUC) of the receiver operating characteristic (ROC) curve was not associated with plaque presence for the Modification of Diet in Renal Disease (MDRD) equation (p = 0.3), whereas the respective relationship was significant or borderline significant (p = 0.003 to 0.08) and of similar extent (p>0.1 for comparisons of AUC (SE)) for the other 8 equations

  • Reduced kidney function is independently associated with atherosclerosis and endothelial activation in black and white Africans with rheumatoid arthritis (RA), respectively

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Summary

Introduction

In 1974, Lindner and colleagues [1] reported that atherosclerotic coronary heart disease (CHD) risk is increased in patients on dialysis. Dialyzed patients experience increased mortality due to sudden death and heart failure more frequently than from atherosclerotic CHD [2]. Mild renal impairment elevates cardiovascular disease (CVD) risk [3]. Patients with RA sustain an increased risk of CVD [4,5]. Reduced kidney function development is enhanced in patients with RA compared to non-RA persons and increases the risk of cardiovascular events in RA [6,7]. The potential impact of impaired kidney function on atherogenic mechanisms including endothelial activation and atherosclerosis in RA requires elucidation

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