Kidney Week

Abstract: TH-PO0571

Competing Risks of Cardiovascular Disease, CKD Progression, and Mortality in Stage 3 CKD

Session Information

• CKD: From Global Burden to Precision Care - Epidemiology, Demographics, Geographies, and Risk Factors
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2201 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Saperstein, Yiela, Staten Island University Hospital, New York, New York, United States

Yiela Saperstein, MD, MS

• Zaidan, Nadim, Staten Island University Hospital, New York, New York, United States

Nadim Zaidan, MD

• Bou Sanayeh, Elie, Staten Island University Hospital, New York, New York, United States

Elie Bou Sanayeh, MD, MBA

• Coppa, Kevin, Northwell Health, New Hyde Park, New York, United States

Kevin Coppa, MS

• Chung, Paul J., Northwell Health, New Hyde Park, New York, United States

Paul J. Chung, MD

• El Sayegh, Suzanne E., Staten Island University Hospital, New York, New York, United States

Suzanne E. El Sayegh, MD, FASN

• Bonifant, George C., Staten Island University Hospital, New York, New York, United States

George C. Bonifant, MD, FASN

Background

In early chronic kidney disease (CKD), the risk of cardiovascular (CV) events exceeds the risk of further kidney function decline. Despite this known pattern, predictive tools incorporating dual risks in individual patient trajectories remain limited. This study aimed to evaluate the competing risks of CV events, CKD progression, and mortality in an outpatient cohort.

Methods

This retrospective cohort study included patients with stage 3 CKD (eGFR 30-60 mL/min/1.73 m2) and without CV disease at baseline. Patients were identified from the Northwell Health outpatient clinics across 2018-2019 and followed through 2024. Baseline data collected included demographics, comorbidities, laboratory values, vitals, and medication use. The primary outcomes were: (1) CKD progression, defined as two consecutive eGFR decline by ≥40% from baseline or decline to <15 mL/min/1.73 m2, at least 90 days apart; (2) incident CV events (composite of atherosclerotic CVD, arrhythmias, and heart failure identified through ICD10 codes); or (3) all-cause mortality. Fine–Gray competing-risks regression was used with multivariate imputation by chained equations for missingness. Analyses were conducted using R 4.5 and results reported as subdistribution hazard ratios (sHR) with 95% confidence intervals.

Results

The final cohort included 25,624 patients (42.95% male) with a mean age of 70.45 years and mean baseline eGFR of 50.1 mL/min/1.73 m2. Hypertension was present in 46.05%, diabetes in 20.57%, and dyslipidemia in 32.62%. CKD progression, CVD and death occurred in 3008, 9465 and 1747 patients respectively. Diabetes and hypertension were strongly associated with CKD progression (sHR 1.84 [1.68–2.01] and 1.28 [1.18–1.40]), as well as anemia and hypocalcemia. For CV events, key risk factors included male sex and lower baseline eGFR, while diabetes (sHR 0.90 [0.85–0.95]), diastolic BP (sHR 0.995 [0.991–0.998]) and total cholesterol (sHR 0.98 [0.96–0.99]) were not associated with higher risk. Albumin level and statin use were most strongly associated with decreased mortality.

Conclusion

Distinct clinical factors underly CKD progression, CV events, or mortality as competing outcomes in CKD patients. These findings highlight the need for patient-centered models to improve individualized risk assessment. Next steps will involve leveraging machine learning to enhance trajectory prediction.

Acknowledgment

This study was supported by the REACH Award, funded by Bayer, the National Kidney Foundation and Women in Nephrology.

Funding

• Commercial Support – Bayer