Major CV Events and Subsequent Risk of Kidney Failure

Apr 12, 2023
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Authors:
Mark PB, Carrero JJ, Matsushita K, et al.
Citation:
Major Cardiovascular Events and Subsequent Risk of Kidney Failure With Replacement Therapy: A CKD Prognosis Consortium Study. Eur Heart J 2023;44:1157-1166.
Summary By:
Debabrata Mukherjee, MD, FACC

Quick Takes

  • There are strong associations between major CVD events and subsequent risk of kidney failure with replacement therapy (KFRT).
  • The risk of KFRT was conspicuously elevated after incident HF, but also after CHD, stroke, and AF.
  • Patients, clinicians, and health care systems managing major CVD need to optimize long-term care to ensure that those at highest risk receive appropriate evaluation, counseling, therapy, and referral for management of progressive CKD.

Study Questions:

What is the association of cardiovascular disease (CVD) incidence, prevalence, and subtypes on subsequent risk of kidney failure with replacement therapy (KFRT)?

Methods:

The investigators included 25,903,761 individuals from the CKD Prognosis Consortium with known baseline estimated glomerular filtration rate (eGFR) and evaluated the impact of prevalent and incident coronary heart disease (CHD), stroke, heart failure (HF), and atrial fibrillation (AF) events as time-varying exposures on KFRT outcomes. Time to event analysis was analyzed for each CVD event separately with follow-up from baseline as the time scale.

Results:

Mean age was 53 (standard deviation 17) years and mean eGFR was 89 mL/min/1.73 m2, 15% had diabetes, and 8.4% had urinary albumin-to-creatinine ratio available (median 13 mg/g); 9.5% had prevalent CHD, 3.2% prior stroke, 3.3% HF, and 4.4% prior AF. During follow-up, there were 269,142 CHD, 311,021 stroke, 712,556 HF, and 605,596 AF incident events and 101,044 (0.4%) patients experienced KFRT. Both prevalent and incident CVD were associated with subsequent KFRT with adjusted hazard ratios (HRs) of 3.1 (95% confidence interval [CI], 2.9–3.3; 2.0 [1.9–2.1]; 4.5 [4.2–4.9]; 2.8 [2.7–3.1]) after incident CHD, stroke, HF and AF, respectively. HRs were highest in the first 3 months post-CVD incidence, declining to baseline after 3 years. Incident HF hospitalizations showed the strongest association with KFRT (HR, 46; 95% CI, 43–50 within 3 months) after adjustment for other CVD subtype incidence.

Conclusions:

The authors report that incident CVD events strongly and independently associate with future KFRT risk, most notably after HF, then CHD, stroke, and AF.

Perspective:

This large multinational meta-analysis reports strong associations between major CVD events and subsequent risk of KFRT. The risk of KFRT was conspicuously elevated after incident HF, but also after CHD, stroke, and AF. Given the poor clinical and patient-reported outcomes as well as the excessive health care costs of KFRT, these data underscore need of detection and monitoring of kidney disease measures, including eGFR and albuminuria, as well as on need of therapeutic strategies to delay KFRT after CVD events. Furthermore, patients, clinicians, and health care systems managing major CVD need to optimize long- term care to ensure that those at highest risk receive appropriate evaluation, counseling, therapy, and referral for management of progressive CKD.

Clinical Topics: Arrhythmias and Clinical EP, Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure

Keywords: Albumins, Albuminuria, Arrhythmias, Cardiac, Atrial Fibrillation, Coronary Disease, Counseling, Creatinine, Glomerular Filtration Rate, Heart Failure, Kidney Diseases, Kidney Failure, Chronic, Myocardial Ischemia, Primary Prevention, Renal Insufficiency, Chronic, Risk, Stroke, Vascular Diseases


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