Abstract: SA-PO0444
Cardiovascular Testing Among Veterans with CKD
Session Information
- CKM: Clinical - Screening, Population Management, Care Disparities, and Patient-Centered Outcomes
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Cardiovascular-Kidney-Metabolic Health
- 602 Cardiovascular-Kidney-Metabolic Health: Clinical
Authors
- Gregg, Lucile Parker, Baylor College of Medicine, Houston, Texas, United States
- Vu, Christine, VA North Texas Health Care System, Dallas, Texas, United States
- Yang, Hui, Texas Tech University Health Sciences Center, Lubbock, Texas, United States
- Gaweda, Adam E., VA Robley Rex Medical Center, Louisville, Kentucky, United States
- Alvarez, Carlos A., VA North Texas Health Care System, Dallas, Texas, United States
- Lederer, Eleanor D., VA North Texas Health Care System, Dallas, Texas, United States
Background
Cardiovascular (CV) disease risk increases with chronic kidney disease (CKD) progression. We hypothesized that the frequency of CV testing would increase with each stage of CKD.
Methods
Using the Department of Veterans Affairs database from 1/1/2013-12/31/2019, we identified Veterans diagnosed with CKD by standard definition and quantified the number undergoing CV tests after CKD diagnosis, including lipid profile, coronary artery calcification CT (CAC), transthoracic echocardiogram (TTE), coronary angiography (cath), femoropopliteal angiography (FP angio), ankle-brachial index (ABI), and carotid doppler. Multivariable Cox proportional hazards assessed association of CKD stage with CV testing, adjusted for age, sex, race, ethnicity, diabetes, hypertension, hyperlipidemia, body mass index, heart failure, myocardial infarction, peripheral vascular disease, cerebrovascular disease.
Results
Of 1,444,149 Veterans, 93,246 (6%) had stage 1; 134,031 (9%) stage 2; 906,784 (63%) stage 3a; 234,380 (16%) stage 3b; 54,646 (4%) stage 4; and 21,062 (2%) stage 5 CKD. Higher stage CKD correlated with older age, male sex, Black race, higher prevalence of hypertension and heart failure. Over 1972 (IQR: 1365-2701) days of follow up, 1,373,281 (95%) had a lipid profile; 3317 (0.2%) CAC; 49,143 (3%) TTE; 13,009 (0.9%) cath; 6279 (0.4%) FP angio; 4479 (0.3%) ABI; and 7432 (0.5%) carotid doppler. The likelihood of most CV testing actually decreased from Stage 1 through Stage 3. Measurement of lipids and CAC remained low through Stage 5. However, utilization of the remaining tests increased slightly in Stage 4 and exceeded reference rates at Stage 5 (Table).
Conclusion
Low utilization of CV assessment tools, particularly in earlier stages of CKD, likely reflects lack of awareness of the greater CV risk in CKD and the lack of screening guidelines for CKD. These factors may contribute to missed opportunities for preventive measures.
| CV test | Stage 1 N=93,246 | Stage 2 N=134,031 HR (95% CI) | Stage 3a N=2,906,784 HR ((%% CI) | Stage 3b N=234,380 HR (95% CI) | Stage 4 54,646 HR (95% CI) | Stage 5 N=21,062 HR (95% CI) |
| Lipid panel | Ref | 1.05 (1.04, 1.06) | 0.42 (0.42, 0.43) | 0.32 (0.31, 0.32) | 0.29 (0.28, 0.29) | 0.27 (0.26, 0.27) |
| CAC | Ref | 0.81 (0.71, 0.92) | 0.17 (0.15, 0.19) | 0.09 (0.07, 0.10) | 0.08 (0.06, 0.11) | 0.11 (0.08, 0.15) |
| TTE | Ref | 0.87 (0.83, 0.92) | 0.63 (0.61, 0.66) | 0.65 (0.63, 0.68) | 0.87 (0.82, 0.92) | 1.20 (1.12, 1.28) |
| Cath | Ref | 1.04 (0.96, 1.13) | 0.71 (0.66, 0.76) | 0.67 (0.62, 0.73) | 0.81 (0.73, 0.90) | 1.03 (0.91, 1.17) |
| FP angio | Ref | 0.83 (0.74, 0.93) | 0.51 (0.47, 0.57) | 0.56 (0.50, 0.62) | .97 (0.85, 1.10) | 1.4 (1.22, 1.61) |
| ABI | Ref | 0.82 (0.71, 0.94) | 0.46 (0.41, 0.51) | 0.50 (0.44, 0.57) | 0.77 (0.65, 0.90) | 1.13 (0.94, 1.35) |
| Carotid doppler | Ref | 0.91 (0.80, 1.03) | 0.71 (0.64, 0.79) | 0.71 (0.64, 0.80) | 1.03 (0.89, 1.19) | 1.30 (1.09, 1.56) |
Funding
- Veterans Affairs Support