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Abstract: TH-PO447

Impact of Cardiovascular Events on Mortality and Decline of Renal Function in Patients with CKD

Session Information

Category: Hypertension and CVD

  • 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention

Authors

  • Mallett, Andrew John, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
  • Jeyaruban, Andrew Sujeevan, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
  • Cameron (Salisbury), Anne, The University of Queensland, Brisbane, Queensland, Australia
  • Zhang, Jianzhen, The University of Queensland, Brisbane, Queensland, Australia
  • Healy, Helen G., Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
  • Hoy, Wendy E., The University of Queensland, Brisbane, Queensland, Australia

Group or Team Name

  • on behalf of the CKD.QLD consortium
Background

CVEs are common and significant complications amongst patients with CKD. The association of CKD and CVE is well publicised. However, the impact of CVE on subsequent kidney survival is not well described. We aimed to study the impact of new cardiovascular events (CVE) on mortality and deterioration of kidney function in a prevalent chronic kidney disease (CKD) patient cohort.

Methods

A retrospective cohort study of 1,123 patients of a tertiary teaching hospital, registered in the CKD.QLD registry between January 2011 and August 2017 and with a minimum of 2 years follow up time. CVE data (ischaemic heart disease (IHD), stroke and peripheral vascular disease (PVD)), renal function (eGFR CKD-EPI) and mortality events were extracted from integrated medical records. Subjects who progressed to end stage kidney disease were imputed an eGFR 8mL/min/1.73m2 at the date of kidney replacement therapy (KRT). Delta eGFR (mL/min/1.73 m2/year, (CKD-EPI)was calculated as the difference between latest eGFR compared to at time of incident CVE.

Results

222 patients had at least one incident CVE which included IHD (n=144), stroke (n=51) or PVD (n=40). CVE events had a significant (p<0.05) impact on mortality, even after adjusting for age, gender and/or history of prior IHD, stroke and/or PVD. Kaplan-Meier analysis showed survival was reduced by 700 days (2867 (SE=67) vs 2167 (SE=61)) in the CVE cohort (p<0.01).

There was no significant change in the absolute mean delta eGFR in subjects with and without CVE, adjusted for age (2.6mL/min/1.73 m2/year (SE=0.4) vs 1.7mL/min/1.73 m2/year (SE=0.2); p=0.2). Nor was there a significant different in progression to KRT, adjusting for age, gender and previous IHD, stroke and PVD (CVE 11.5% vs no CVE 10.4%; p=0.6).

Conclusion

New cardiovascular events are a flag for premature mortality in the CKD cohort as they are for the general population. However, patients with the shortest survival could have been excluded due to the exclusion criteria of the study. Moreover, incident CVE do not seem to have a significant association with accelerated progression of renal dysfunction or transition to KRT in CKD patients.