Study of the effect of chronic kidney disease on the incidence of cardiovascular events in a native Spanish population

Abstract

AimsTo evaluate the relationship between chronic kidney disease and the patient's cardiovascular risk measured through the incidence of major adverse cardiovascular events in a sample of Spanish population. Design and methodsThe sample consisted of 2668 subjects. Mean age was 50.6 ± 14.5 years and 54.6% were female. In all, 3.5% of subjects had a glomerular filtration rate (GFR) below 60 ml/min and 4.3% a urinary albumin excretion (UAE) above 30 mg/g. GFR was estimated from serum creatinine using the CKD-EPI equation. UAE was measured in first morning urine sample as mg/g of creatinine. We examined the multivariable association between the estimated GFR and the risks of cardiovascular events and death. The median follow-up was 81 (75–89) months. ResultsIn CKD patients the hazard ratio (HR) was 1.36 (95% CI 0.97–1.91) (P = .079) for cardiovascular events and 1.62 (95% CI 0.53–4.91) (P = .396) for cardiovascular mortality. Increased UAE was also associated with higher cardiovascular risk (HR 2.38; 95% CI 1.51–3.74; P < .001) as well as increased cardiovascular mortality (HR 4.78; 95% CI 2.50k9.11; P < ..001). For patients with UAE between 30 and 300 mg/g HR for cardiovascular events was 2.09 (95% CI 1.34–3.50; P = .005) and 3.80 (95% CI 1.81–7.96; P < .001) for cardiovascular mortality. ConclusionsAn independent association was found between reduced GFR and cardiovascular event incidence and mortality. Increased UAE showed a higher prognostic value than decreased GFR. Our findings highlight the clinical and public health importance of routinely measuring UAE.