Original InvestigationPathogenesis and Treatment of Kidney DiseaseImpact of Age on the Association Between CKD and the Risk of Future Coronary Events
Section snippets
Database and Participants
We used the Alberta Kidney Disease Network population-based database7 (Fig S1, available as online supplementary material) to identify adults (N = 2,004,791) 18 years and older with at least one outpatient serum creatinine measurement and albuminuria between 2002 and 2009. The first available serum creatinine value and the corresponding date were set as the index serum creatinine level and index date, respectively.
We excluded people with index eGFR < 15 mL/min/1.73 m2 prior to cohort entry and those
Study Participants
Table 1 shows characteristics of the 1,268,538 participants in the primary cohort and subgroup of 1,164,270 participants who were free of diabetes and prior MI at baseline. People with CKD tended to be older and have more comorbid conditions than those with normal kidney function. In the main analysis cohort, over a median follow-up of 49 months, 7,050 died of CHD and 11,240 were hospitalized for MI. Thus, death due to coronary disease accounted for approximately 39% of the composite outcome.
Discussion
A large body of evidence shows that people with CKD are at high coronary risk, especially when albuminuria is present and at lower eGFRs.18, 19, 20 Previous work from our group shows that eGFRs < 60 mL/min/1.73 m2 (with or without albuminuria) are associated with future absolute coronary risk that is comparable to that for people with diabetes.5 This finding highlighted the potential merit of considering all patients with CKD as being at the highest risk of future coronary events.3, 4
Recent
Acknowledgements
Support: This work was supported by an interdisciplinary team grant from the Alberta Innovates Health Solutions. Drs Tonelli, Klarenbach, and Manns were supported by career salary awards from the Alberta Heritage Foundation for Medical Research. Dr Tonelli was also supported by a Government of Canada Research Chair in the optimal care of people with CKD, and Dr Hemmelgarn, by the Roy and Vi Baay Chair in Kidney Research. Drs Hemmelgarn, Klarenbach, Manns, and Tonelli were all supported by a
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Changes in kidney function follow living donor nephrectomy
2020, Kidney InternationalAlbuminuria and posttransplant chronic kidney disease stage predict transplant outcomes
2017, Kidney InternationalCitation Excerpt :Index eGFR was categorized based on the 2012 KDIGO stages of CKD according to eGFR values of ≥60, 45 to 59, 30 to 44, and 15 to 29 ml/min per 1.73 m2.1 Albuminuria was defined by ACR, PCR, or urine dipstick based on outpatient random spot urine measurements and categorized based on the KDIGO definition as normal (A1: ACR <30 mg/g, PCR <15 mg/mmol, or dipstick negative), mild (A2: ACR 30–300 mg/g, PCR 15–100 mg/mmol, or dipstick trace or 1+), or heavy (A3: ACR >300 mg/g, PCR >100 mg/mmol, dipstick ≥2+).1,24,33,34 ACR was the primary measure of albuminuria, and, if unavailable, was supplemented with PCR measurements.
Comparative Effectiveness of Surgical Treatments for Small Renal Masses
2017, Urologic Clinics of North AmericaCitation Excerpt :For example, when compared with patients with normal renal function, patients with stage III CKD had higher hazard ratios for all-cause mortality (1.8; 95% confidence interval [CI] 1.7–1.9) and cardiovascular events (2.0; 95% CI 1.9–2.1). Other population-based studies have also produced similar findings in which declines in estimated glomerular filtration rate (eGFR) correlated with higher all-cause mortality and risk of ESRD.23–25 Nevertheless, these studies may be limited in their clinical applicability for patients diagnosed with SRMs and undergoing kidney surgery, because the adverse health outcomes were attributable to medical CKD rather than surgical CKD from RN or ischemia time from PN.
Prognostic role of LDL cholesterol in non-dialysis chronic kidney disease: Multicenter prospective study in Italy
2015, Nutrition, Metabolism and Cardiovascular DiseasesCitation Excerpt :Non-dialysis chronic kidney disease (ND-CKD) is characterized by progression to end stage renal disease (ESRD) and an excess cardiovascular (CV) risk that is so high that premature death is now assimilated to ESRD as a natural fate in these patients [1]. This concept has been reinforced by recent studies that identified CKD as a “coronary heart disease risk equivalent” [2,3]. Nevertheless, the CV risk associated with cholesterol levels has been investigated in ND-CKD by few studies and with controversial results [4–9].
KDOQI US commentary on the 2013 KDIGO clinical practice guideline for lipid management in CKD
2015, American Journal of Kidney DiseasesCitation Excerpt :Treatment recommendations should be based on both the underlying risk and published evidence that treatment decreases this risk. Individuals older than 50 years with albuminuria, the most common marker identifying structural CKD in those with eGFR ≥ 60 mL/min/1.73 m2, are at increased risk of CHD events.7,23 However, there are no randomized trials indicating that statin treatment of this population decreases the risk of CHD.
Cardiovascular disease prevention in CKD
2014, American Journal of Kidney Diseases
No paper or electronic reprints will be available.
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A list of the members of the Alberta Kidney Disease Network is available at www.akdn.info.