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Kidney Week

Abstract: PO2357

Major Cardiovascular Events and Subsequent Risk of Kidney Failure: A CKD Prognosis Consortium Study

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Mark, Patrick B., CKD Prognosis Consortium, Baltimore, Maryland, United States
  • Carrero, Juan Jesus, CKD Prognosis Consortium, Baltimore, Maryland, United States
  • Visseren, Frank L.J., CKD Prognosis Consortium, Baltimore, Maryland, United States
  • Stengel, Benedicte, CKD Prognosis Consortium, Baltimore, Maryland, United States

Group or Team Name

  • Chronic Kidney Disease Prognosis Consortium
Background

Chronic kidney disease (CKD) increases risk of cardiovascular disease (CVD). However, less is known about how CVD is associated with future risk of kidney failure. We quantified the association of incident major CVD events with subsequent risk of kidney failure requiring replacement therapy (KFRT).

Methods

We analyzed data on 18,671,338 individuals from 80 cohorts in the CKD Prognosis Consortium with baseline eGFR and CVD data. We assessed impact of incident coronary heart disease (CHD), heart failure (HF), atrial fibrillation (Afib) and stroke events as a time-varying exposure on the outcome of KFRT in Cox proportional hazard models.

Results

Mean age was 53 years and mean eGFR was 88 ml/min/1.73m2, 57% were women, 9% were black, 12% had diabetes and 30% had ACR available (median 13 mg/g); 9% had prevalent CHD, 3% HF, 2% Afib, and 4% prior stroke. During follow up there were 175,886 CHD, 480,963 HF, 428,419 Afib and 211,423 stroke incident events and 85,513 (0.5%) patients required KFRT. Each CVD event increased the adjusted hazard ratio (HR) for subsequent KFRT (Table). The increased hazard was highest in the first year after CVD incidence and attenuated thereafter. HRs were modestly weaker at lower eGFR. HF showed the strongest association before and after adjustment for other CVD subtype incidence. Absolute risk of KFRT associated with incident CVD after accounting for competing risk of mortality was higher for lower baseline eGFR and higher ACR, with 2-year KFRT risk of 25%, 28%, 20% and 20% for CHD, HF, Afib and stroke in subjects with eGFR 15-29 ml/min/1.73m2 and ACR >300 mg/g.

Conclusion

Incident CVD events are strongly and independently associated with risk for KFRT, with greatest risk in the first year following HF, then CHD and stroke. These data highlight need for greater awareness of KFRT risk following CVD events. Specific strategies to elucidate mechanisms and test interventions to reduce the KFRT risk post CVD events warrant investigation.

Funding

  • NIDDK Support