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Kidney Week

Abstract: PO2119

The Relationship of Cardiovascular Morbidity with Death and End-Stage Kidney Failure in Patients with Diabetes and CKD Receiving Specialist Renal Care

Session Information

Category: Hypertension and CVD

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

Authors

  • Tan, Ken-Soon, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
  • McDonald, Stephen P., Australia and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia

Group or Team Name

  • CKD.QLD
Background

Patients with diabetes (DM) and CKD have worse cardiovascular, renal and mortality outcomes than those with neither and either condition alone. However, relationships between these 3 outcomes remain unclear, especially in patients receiving specialist renal care.

Aims: To determine the relationship of major adverse cardiovascular event (MACE), end stage kidney failure (ESKF) and death using competing risk analysis.

Methods

CKD.QLD is a large Australian registry of patients with CKD not on RRT receiving specialist renal care. Patients with DM enrolled between 1/1/2011 and 31/12/2016 inclusive were studied. Follow-up was censored by death, ESKF, 1st MACE post enrolment, movement of patient interstate/overseas, loss to follow-up or censor date of 31/12/2017, whichever occurred first. Competing risk analysis was performed with MACE, ESKF and death in turn as the primary outcome whilst the other 2 were competing risks. Covariates examined were age, gender, ethnicity, incident status, access to services, biopsy, smoking, diabetes treatment, Hba1c, MACE prior to enrolment, eGFR, proteinuria, Hb, RAAS blocker and lipid lowering therapy.

Results

2355 patients underwent 6615 patient-years follow-up (pyfu), mean 2.8y. The first event was MACE in 571 patients (24.2%), ESKF in 299 patients (12.6%) and death in 268 patients (11.3%), giving respective event rates of 86, 45 and 41 per 1000 pyfu. 1137 patients (48.3%) experienced no event.
Table 1 summarises the results of the best fit multivariable model with each primary outcomes. p < 0.05 was deemed significant.

Conclusion

Despite advances in cardiovascular risk management, MACE remains the dominant clinical outcome in diabetic CKD patients who are nearly twice as likely to experience a MACE first then they are to die or develop ESKF. One hypothesis is that advances in cardiovascular risk management may also concurrently decrease risk of CKD progression and delay death. The most consistent predictors of outcome were age and MACE prior to enrolment. Of note, neither ethnicity nor access to services predicted outcome.

Table 1: summary of competing risk analysis with the different primary outcomes.
Primary outcomeCompeting risksPositive predictorsNegative predictors
MACEESKF, DeathAge, proteinuria, HbA1c, Prior MACEN/A
ESKFMACE, DeathGFR, proteinuria, prior MACEAge
DeathMACE, ESKFAge, smoking, prior MACEHb