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Abstract: SA-OR36

Risk of Cardiovascular Events Is Higher in Patients with Glomerular Disease Compared with the General Population

Session Information

Category: Hypertension and CVD

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

Authors

  • Gunning, Heather M., BC Provincial Renal Agency, Vancouver, British Columbia, Canada
  • Canney, Mark, Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
  • Reich, Heather N., Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
  • Zheng, Yuyan, BC Provincial Renal Agency, Vancouver, British Columbia, Canada
  • Sahota, Anahat, School of Medicine, University of British Columbia, Canada, Vancouver, British Columbia, Canada
  • Hur, Seo Am, School of Medicine, University of British Columbia, Canada, Vancouver, British Columbia, Canada
  • Jauhal, Arenn Singh, Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
  • Barbour, Sean, Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
  • Rose, Caren L., British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
Background

Cardiovascular (CV) disease is a recognized cause of morbidity and mortality in chronic kidney disease; however, understanding of CV risk in patients with glomerular disease (GN) is limited. We sought to define CV risk in GN patients and compare incidence rates to the general population.

Methods

A centralized kidney pathology registry (2000-2012) was used to capture all incident cases of focal segmental glomerulosclerosis (FSGS, n=540), IgA nephropathy (IgAN, n=759), membranous nephropathy (MN, n=387), and minimal change disease (MCD, n=226) in British Columbia, Canada. The primary outcome was a composite of major CV events, ascertained from a hospital discharge registry and evaluated using the Kaplan-Meier method. Hazard ratios (HR, 95% CI) were determined using Cox proportional hazards regression. Event rates were age and sex standardized to the general adult population to generate standardized incidence ratios (SIR, 95% CI).

Results

Over a median follow-up of 6.8years there were 338 CV events; 10-year risk (95% CI) was 16.0% (13.8-18.3) and differed by GN type (Figure): IgAN=7.7% (5.4-10.4), MCD=13.2% (7.6-20.4), MN=19.4% (14.3-25.0), and FSGS=27.0% (21.9-32.4). Compared to IgAN, MN (HR=2.6, 1.7-3.9) and FSGS (HR=3.7, 2.6-5.3) had higher risk, but MCD (HR=1.3, 0.8-2.4) did not. Results were similar when comparing CV events before versus after ESKD. CV risk in GN patients was 2.5-fold higher than the general population (SIR 2.5, 2.1-2.8), and was higher in each GN subtype (IgAN=1.4, 1.0-1.8; MCD=1.8, 1.0-2.8; MN=3.0, 2.2-4.0; FSGS=4.0, 3.2-4.9).

Conclusion

Patients with GN are at high risk of CV disease, both before and after ESKD onset. The CV risk for all GN subtypes was higher than the general population, including MCD and IgAN. This suggests CV preventive strategies should be considered in all patients with GN.

Kaplan-Meier Curve by GN Type