Abstract: PO1767
Patients with CKD and Multiple Chronic Conditions Are at Increased Risk of Cardiovascular Events
Session Information
- Hypertension and CVD: New insights
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention
Authors
- Sullivan, Michael K., University of Glasgow, Glasgow, Glasgow, United Kingdom
- Jani, Bhautesh Dinesh, University of Glasgow, Glasgow, Glasgow, United Kingdom
- Mair, Frances S., University of Glasgow, Glasgow, Glasgow, United Kingdom
- Mark, Patrick B., University of Glasgow, Glasgow, Glasgow, United Kingdom
Background
Major adverse cardiovascular events (MACE) are the leading cause of mortality in chronic kidney disease (CKD). We studied the relationship between the number and type of multiple chronic conditions (MCCs) and the risk of MACE in patients with CKD.
Methods
We retrospectively examined the SAIL Databank: a cohort consisting of the population of Wales, UK (2011-2018). Patients were categorised by the number of MCCs additional to CKD: the primary analysis included all MCCs (e.g. asthma, depression), and a secondary analysis excluded cardiometabolic conditions (hypertension, ischaemic heart disease, cerebrovascular disease, heart failure, atrial fibrillation, peripheral vascular disease, diabetes). The outcome was MACE: myocardial infarction, stroke, heart failure hospitalisation. The risk of MACE associated with number of MCCs was calculated using cox proportional hazards models. Adjustments were made for age, sex, smoking, deprivation, eGFR and cholesterol.
Results
Of the 173,388 patients with CKD, median age was 78 years, 57% were female, 98.6% were of white ethnicity and median eGFR was 51ml/min/1.73m2. There was a graded rise in the risk of MACE by MCC count (Figure 1): 1 condition adjusted hazard ratio (aHR) 1.15 (1.02-1.29), 2 MCCs aHR 1.37 (1.22-1.53), 3 MCCs 1.68 (1.50-1.88), ≥4 MCCs 2.61 (2.34-2.92). For non-cardiometabolic conditions, MACE risk was lessened, but the trend persisted: 1 condition aHR 1.16 (1.12-1.20), 2 MCCs aHR 1.30 (1.25-1.35), 3 MCCs 1.43 (1.38-1.49), ≥4 MCCs aHR 1.65 (1.59-1.71).
Conclusion
Patients with CKD and MCCs are at high risk of MACE, even when cardiometabolic conditions are excluded. Cardiovascular risk stratification and preventative strategies in patients with CKD should take into account the number and type of other chronic conditions.
Figure 1. Cox regression for MACE. *Adjusted for age, sex, smoking, deprivation, eGFR & cholesterol
Funding
- Other NIH Support