Abstract: PO2391
Patient-Reported Symptoms and Subsequent Risk of Myocardial Infarction in CKD
Session Information
- CKD: Insights from Recent Clinical Trials and Large Real-World Effectiveness Studies
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Lidgard, Benjamin, University of Washington, Seattle, Washington, United States
- Zelnick, Leila R., University of Washington, Seattle, Washington, United States
- O'brien, Kevin D., University of Washington, Seattle, Washington, United States
- Bansal, Nisha, University of Washington, Seattle, Washington, United States
Background
Patient-reported symptoms often precede clinical acute presentations of atherosclerotic cardiovascular disease (ASCVD), and include chest pain, shortness of breath, and inability to climb stairs. Patients on dialysis frequently have atypical or absent symptoms related to ASCVD; however, it is unknown whether these same findings are observed in patients with non-dialysis requiring chronic kidney disease. We examined time-updated symptoms of ASCVD and their associations with incident acute myocardial infarction (MI) in a large prospective CKD cohort.
Methods
We studied participants from the Chronic Renal Insufficiency Cohort (CRIC) study who had available symptom data. Chest pain, shortness of breath, and inability to climb stairs were evaluated using the Kidney Disease Quality of Life Instrument (KDQOL-36) at each annual study visit, and were categorized as “no symptoms”, “mild symptoms”, and “moderate or worse symptoms”. Associations between categorical time-updated symptoms and interim MI were assessed using Cox regression models with adjustment for potential confounders. We tested for interaction by prior MI, eGFR, and diabetes.
Results
Among 3909 study participants, the mean age was 58 years, and the mean eGFR was 44.3 mL/min/1.73 m2; 22% had prior MI. There were 367 MIs over a median of 7.98 years; median time between symptom assessment and MI was 213 days (IQR 111 to 314 days). Moderate or worse shortness of breath was associated with 1.83-fold increased risk of MI (95% CI 1.25, 2.67) after adjustment. These associations were also seen for chest pain and inability to climb stairs (HR for moderate or worse chest pain 1.65, HR for severe limitation climbing stairs 1.85) (Table). P-values for interaction by prior MI, diabetes, and eGFR were all not statistically significant (p>0.05).
Conclusion
Chest pain, shortness of breath, and inability to climb stairs were significantly associated with increased risk of MI in a large cohort of participants with CKD. This highlights the importance of symptom assessment as early warning signs of ASCVD in patients with CKD.
Funding
- NIDDK Support