Abstract: SA-PO1119
Association Between Longitudinal eGFR and Sudden Cardiac Death Among CKD Patients
Session Information
- CKD Epidemiology, Risk Factors, Prevention - III
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Delannoy, Jean, Centre de Recherche en Epidemiologie et Sante des Populations, Villejuif, Île-de-France, France
- Faucon, Anne-Laure, Centre de Recherche en Epidemiologie et Sante des Populations, Villejuif, Île-de-France, France
- Metzger, Marie, Centre de Recherche en Epidemiologie et Sante des Populations, Villejuif, Île-de-France, France
- Liabeuf, Sophie, Universite de Picardie Jules Verne, Amiens, Hauts-de-France, France
- Massy, Ziad, Centre de Recherche en Epidemiologie et Sante des Populations, Villejuif, Île-de-France, France
- Mansencal, Nicolas, Hopital Ambroise-Pare, Boulogne-Billancourt, Île-de-France, France
- Stengel, Benedicte, Centre de Recherche en Epidemiologie et Sante des Populations, Villejuif, Île-de-France, France
- Alencar de Pinho, Natalia, Centre de Recherche en Epidemiologie et Sante des Populations, Villejuif, Île-de-France, France
Background
The risk of sudden cardiac death (SCD) is high among dialysis dependent patients, but is poorly characterized in earlier chronic kidney disease (CKD) stages. We aimed at analyzing the relation between longitudinal eGFR and the risk of SCD in patients with moderate to severe CKD.
Methods
We analyzed data from the CKD-REIN cohort study, which enrolled adult patients with CKD stage 3 to 5 from 40 nationally representative outpatient nephrology clinics in France. All cardiovascular (CV) deaths were reviewed, and causes were adjudicated by two cardiologists. Crude and adjusted hazard ratios (HR) and 95% confidence intervals (CI) of SCD and other CV deaths associated with current eGFR value and slope were estimated with shared frailty joint models. Non-CV death and kidney replacement therapy were competing events. Models were adjusted for age, gender, urine albumin-creatinine ratio, diabetes, systolic blood pressure, body mass index, smoking, alcohol consumption and education.
Results
We included 3020 patients: 65% men, mean age 67±13 years, eGFR 34±13 mL/min/1.73m2, 30% with history of heart failure or coronary heart disease. Over a median follow-up of 5 years (interquartile range 4.6-5.2), patients underwent 12 (8-17) eGFR measurements, and the mean eGFR slope was -2 mL/min/1.73m2/year. Forty-four SCD and 102 CV deaths from other causes occurred; incidence rates were 3.7 (95% CI 2.7-5.0) and 8.7 (7.1-10.6) per 1000 person-years, respectively. Lower current eGFR value was similarly associated with the risks of SCD and other CV deaths (40 to 60% higher event hazard per 10mL/min/1.73m2 eGFR decrease, with overlapping 95% CI), whereas current eGFR slope was only associated with the risk of other CV deaths (Table).
Conclusion
Patients with more advanced CKD had higher risks of both SCD and CV deaths from other causes, but steeper eGFR decline seemed more closely related with CV deaths other than SCD.
| Model including only current eGFR value and slope | Fully-adjusted model | |||
| HR | 95% CI | HR | 95% CI | |
| Sudden cardiac death | ||||
| - Current eGFR value* | 1.53 | 1.03 - 2.27 | 1.42 | 1.04 - 1.94 |
| - Current eGFR slope** | 0.95 | 0.67 - 1.36 | 0.97 | 0.69 - 1.36 |
| Other CV deaths | ||||
| - Current eGFR value* | 1.61 | 1.33 - 1.95 | 1.58 | 1.27 - 1.97 |
| - Current eGFR slope** | 1.31 | 1.08 - 1.6 | 1.44 | 1.21 - 1.72 |
*per -10 mL/min/1.73m2 **per -2 mL/min/1.73m2/year
Funding
- Commercial Support – Fresenius Medical Care; GlaxoSmithKline; Vifor France; Sanofi-Genzyme; Baxter and Merck Sharp & Dohme-Chibret; Amgen; Lilly France; Otsuka Pharmaceutical; and AstraZeneca.