A 2-Year Prospective Study on the Differences in Prognostic Factors for Major Adverse Cardiovascular, Cerebrovascular and Renal Events Between Patients with Mild and Severe Chronic Kidney Disease

Abstract

Purpose/Method: No studies have reported on prognostic markers in patients with chronic kidney disease (CKD) according to the severity of the disease. Therefore, in this multicenter, prospective trial performed as part of the Gunma CKD SPECT Multicenter Study, we recruited 311 patients with CKD (eGFR <60 min/mL/1.73 m 2 ) including 50 patients on hemodialysis and followed them for 2 years. The study sample underwent stress 99m Tctetrofosmin SPECT for suspected or possible ischemic heart disease. We evaluated the summed stress score (SSS), summed rest score (SRS), summed difference score (SDS) and cardiac function with electrocardiogramgated SPECT. Then, we compared the differences in prognostic markers for major adverse cardiac, cerebrovascular, and renal events (MACCRE) between patients with mild CKD (30 min/mL/1.73 m 2 ≤ eGFR <60 min/mL/1.73 m 2 ; n=184) and those with severe CKD (eGFR <30 min/mL/1.73 m 2 ; n=97). Results: Of 281 patients available for analysis, 91 experienced MACCRE. In a multivariate Cox proportional hazards analysis of factors related to MACCRE, in patients with mild CKD the significant prognostic markers were SDS (P=0.002) and end-systolic volume (ESV, P=0.034); and in the patients with severe CKD, they were eGFR (P=0.03) and diabetes-mellitus (DM, P=0.023). Conclusions: Our findings indicate that SDS and ESV are significant prognostic markers for MACCRE in patients with mild CKD and eGFR and DM are significant prognostic markers in patients with severe CKD.

Long-Term Prognostic Value of Automated Measurements in Nuclear Cardiology: Comparisons with Expert Scoring

“…Zhang et al reported that SSS was the best independent predictor for hard cardiac events, whereas SDS was the strongest independent predictor for soft cardiac events [16]. Previously, in patients with chronic kidney disease, SDS was found to be a significant prognostic marker for major adverse cardiac, cerebrovascular, and renal events [17]. Also, higher SSS was linked to lower event-free survival rate [18].…”