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Abstract: PO1767

Patients with CKD and Multiple Chronic Conditions Are at Increased Risk of Cardiovascular Events

Session Information

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