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Kidney Week

Abstract: FR-PO361

The Make-Up of Cardiovascular Disease as Kidney Function Declines: Results from a Population-Based Australian Cohort Study (EXTEND45)

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Sukkar, Louisa, The George Institute for Global Health, Sydney, New South Wales, Australia
  • Smyth, Brendan, The George Institute for Global Health, Sydney, New South Wales, Australia
  • Kang, Amy, The George Institute for Global Health, Sydney, New South Wales, Australia
  • Jun, Min, The George Institute for Global Health, UNSW Sydney, Newtown, New South Wales, Australia
  • Foote, Celine, The George Institute for Global Health, Sydney, New South Wales, Australia
  • Rogers, Kris, The George Institute for Global Health, Sydney, New South Wales, Australia
  • Neuen, Brendon Lange, The George Institute for Global Health, Sydney, New South Wales, Australia
  • Gallagher, Martin P., The George Institute for Global Health, Sydney, New South Wales, Australia
  • Cass, Alan, Menzies School of Health Research, Darwin, Northern Territory, Australia
  • Pollock, Carol A., The University of Sydney, St. Leonards, New South Wales, Australia
  • Wong, Germaine, The University of Sydney, St. Leonards, New South Wales, Australia
  • Knight, John, The George Institute for Global Health, Sydney, New South Wales, Australia
  • Peiris, David, The George Institute for Global Health, Sydney, New South Wales, Australia
  • Jardine, Meg J., The George Institute for Global Health, UNSW, Newtown, New South Wales, Australia

Group or Team Name

  • EXTEND45 Steering Committee
Background

The pathophysiological process behind cardiovascular morbidity differs between people with Chronic Kidney Disease and the general population. We aimed to examine the relative contributions of myocardial and endoluminal disease to cardiovascular morbidity as kidney function declined.

Methods

Based on data from the EXTEND45 study (the 45 and Up Study linked to hospital and community pathology datasets by the Centre for Health Record and Linkage[CHeReL]), we identified a population-based cohort (2006-2014) of 41,099 people aged ≥45 years who had a measure of kidney function(estimated glomerular filtration rate[eGFR]). Cardiac hospitalisations were identified using ICD-10 codes and classified into endoluminal (all coronary artery disease including complications), myocardial (all cardiac failure and arrhythmias) or other (all valvular disease and infective cardiac processes). We compared the proportion of endoluminal, myocardial and other causes of hospitalisation by KDIGO stage using the Chi-squared test and the trend in proportions between endoluminal and myocardial causes using the Cochran-Armitage trend test.

Results

Of 41,099 participants 3,177 experienced ≥1 hospitalised cardiac event(1901, 837, 439 endoluminal, myocardial and other respectively) over a median follow-up of 1.9 years. Endoluminal causes as a total proportion of cardiac hospitalisation decreased as kidney function declined(64.5%, 61.8%, 57.2%, 53.1%, 50% for Stages 1, 2, 3a, 3b, and 4-5, respectively) while myocardial(26.7%, 25.5%, 27.0%, 28.1%, 29.6% respectively) causes increased(P-value 0.0005) and this trend was significant(P= 0.02). Other causes were also found to increase(8.8%, 12.7%, 15.9%, 18.8%, 20.5% respectively, P-value 0.0005).

Conclusion

The trend towards a decrease in the proportion of endoluminal and an increase in myocardial causes of hospitalisation with kidney function decline was significant. Understanding risk factors that lead to this divergence in cardiovascular morbidity may help reduce the burden.

Funding

  • Commercial Support