Abstract: FR-OR013

Assessing the Impact of CKD Progression on Cardiovascular Disease in a Contemporary UK Cohort of 30,222 Diabetics

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 303 CKD: Epidemiology, Outcomes - Cardiovascular

Author

  • Cabrera, Claudia S., AstraZeneca R&D, Mölndal, Sweden
Background

We evaluated the association between Chronic Kidney Disease (CKD) progression, based on glomerular filtration (eGFR) slope estimates and the risk of cardiovascular disease (CVD) in a contemporary cohort of persons with Type 2 diabetes mellitus (T2DM).

Methods

Incident CKD subjects were selected from a prevalent population of T2DM between Jan 1, 2005 and Dec 31, 2015. Subjects were retrieved from the Clinical Practice Research Data Link (CPRD) in England and followed from CKD diagnosis until event of heart failure (HF), myocardial infarction (MI), ischemic stroke (IS), a composite endpoint including all three event types (MACE plus), mortality, drop out from the database, or end of study. The association between CKD and CVD was estimated using adjusted proportional hazard models (HR 95% CI) in this cohort (n=30,222). The main variables of interest were the updated eGFR slope calculated over multiple overlapping 2 year periods throughout the follow-up time and the updated mean eGFR during these periods with ~ 5 over-lapping slopes/subject and a mean of 11 eGFR values per patient.

Results

The updated eGFR slope predicted CVD outcomes independently of current renal risk (updated mean eGFR) and key risk factors: CVD treatment, smoking, comorbidity, and metabolic risk factors. Both updated mean eGFR (ref ≥60, >30 to 60, ≤30) and the updated eGFR slope (ref ≥3, ≥0 to <3, ≥-3 to <0, ≤ -3) were monotonically associated with MACE plus and HF. Updated eGFR slope decline of ≤- 3 significantly increased the risk of MACE plus (HR 1.45; 95% CI 1.26 - 1.67), HF (HR 1.49; 95% CI 1.27 - 1.76), and MI (HR 1.39; 95% 1.01 - 1.91).

Conclusion

These results indicate that CKD is an independent risk factor for CVD and that rate of progression and cumulative status of CKD elucidate important but distinct aspects of this risk independently of underlying disease such as hypertension and obesity.

Funding

  • Commercial Support