Kidney Week

Abstract: FR-PO0507

Clinical Phenotypes and Outcomes of Cardiovascular Disease in a Real-World CKD Cohort: A Retrospective Analysis

Session Information

• CKM: Clinical - Trials, Epidemiology, and Biomarkers
  October 23, 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

• Bloom, Michelle, Natera Inc, Austin, Texas, United States

Michelle Bloom, PhD

• Clark, Dinah, Natera Inc, Austin, Texas, United States

Dinah Clark, MS

• Raible, Darbey, Natera Inc, Austin, Texas, United States

Darbey Raible, MS

• Arora, Uma, Natera Inc, Austin, Texas, United States

Uma Arora, PhD

• Andrews, Stephen, Natera Inc, Austin, Texas, United States

Stephen Andrews, PhD

• Schneider, Ronen, Natera Inc, Austin, Texas, United States

Ronen Schneider, MD

• Hall, Shelley, Baylor University Medical Center, Dallas, Texas, United States

Shelley Hall, DrMed

• Fischbach, Bernard V., Baylor University Medical Center, Dallas, Texas, United States

Bernard V. Fischbach, MD

• Carey, Sandra A., Natera Inc, Austin, Texas, United States

Sandra A. Carey, PhD, NP, MPH

Background

Cardiovascular disease (CVD) is highly prevalent and a leading cause of morbidity and mortality in individuals with chronic kidney disease (CKD). Despite a well-established overlap, patients frequently have limited care integration. Improved characterization of coexisting CKD and CVD will enable more precise risk stratification to optimize clinical outcomes.

Methods

A retrospective analysis identified patients with CKD with and without coexisting CVD in a real-world database of broad kidney disease genetic testing results (RenasightIQ^TM) linked with a repository of open/closed claims, EHR, and social determinants of health data (Forian’s Hybrid data ecosystem, CHRONOS^TM). Positive genetic results were defined as ≥1 P/LP variant in autosomal dominant/X-linked genes, ≥2 in autosomal recessive genes, or APOL1 dual risk variants (DRV). Clinical characteristics, genetic findings, and end-stage kidney disease (ESKD)-free survival (i.e. time to ICD-10 N18.5/N18.6, eGFR <15, dialysis, or transplant) were assessed.

Results

Among 219,426 patients with genetic and clinical data, 58.0% had CKD only and 35.9% had CKD with coexisting CVD (CKD+CVD); 6.1% of patients lacked a documented CKD diagnosis. Patients with CKD+CVD were older (median 61 vs. 44 years) and had a higher prevalence of stage 4–5 CKD (40.9% vs 17.5%). CKD preceded CVD diagnosis in 56.8% of CKD+CVD cases.

The frequency of kidney-related genetic findings was higher in those with CKD-only compared to those with CKD+CVD (27.9% vs. 22.8%, p<0.001). Notably, the APOL1 DRV prevalence was higher in those with CKD+CVD (6.5% vs. 4.8%, p<0.001), including when restricted to individuals of African ancestry (18.5% vs. 17.5%, p=0.002).

In individuals with CKD, the coexistence of CVD was associated with a greater risk of progression to ESKD (HR 1.81, 95% CI 1.7-1.9, p<0.01), exceeding that associated with APOL1-DRV (HR 1.26, 95% CI 1.2–1.3, p<0.001). Among patients with CKD+CVD, CKD preceding CVD diagnosis conferred higher risk of ESKD than CVD-first diagnosis (HR 1.20, 95% CI 1.1-1.3, p<0.001).

Conclusion

The presence of CVD represents a high-risk subgroup within CKD. Within this group, diagnostic timing and APOL1 status modified ESKD progression risk. These findings highlight the limitations of siloed risk assessment and support a unified approach that integrates clinical and genetic risk across cardiorenal care.

Funding

• Commercial Support – Natera, Inc.