Cardiovascular disease risk factors in chronic kidney disease: A systematic review and meta-analysis

Abstract

Background and objectivesChronic kidney disease (CKD) is a global health burden and is independently associated with increased cardiovascular disease risk. Assessment of cardiovascular risk in the general population using prognostic models based on routinely collected risk factors is embedded in clinical practice. In CKD, prognostic models may misrepresent risk due to the interplay of traditional atherosclerotic and non-traditional risk factors. This systematic review’s aim was to identify routinely collected risk factors for inclusion in a CKD-specific cardiovascular prognostic model.Design, setting, participants and measurementsSystematic review and meta-analysis of observational cohort studies and randomized controlled trials. Studies identified from MEDLINE and Embase searches using a pre-defined and registered protocol (PROSPERO ID—2016:CRD42016036187). The main inclusion criteria were individuals ≥18 years of age with non-endstage CKD. Routinely collected risk factors where multi-variable adjustment for established cardiovascular risk factors had occurred were extracted. The primary outcome was fatal and non-fatal cardiovascular events.ResultsThe review of 3,232, abstracts identified 29 routinely collected risk factors of which 20 were presented in more than 1 cohort. 21 cohorts were identified in relation to 27,465 individuals and 100,838 person-years. In addition to established traditional general population cardiovascular risk factors, left ventricular hypertrophy, serum albumin, phosphate, urate and hemoglobin were all found to be statistically significant in their association with future cardiovascular events.ConclusionsThese non-traditional risk factors should be assessed in the development of future cardiovascular prognostic models for use in individuals with CKD.

Risk and protective factors of co-morbid depression in patients with type 2 diabetes mellitus: a meta analysis

“…Heterogeneity among enrolled studies limits the inter- pretation of the results of meta analysis, particularly in observational studies [35,36]. The ideal method for selecting and combining studies is uncertain, but by limiting the analysis to studies with at least some adjustment for traditional risk factors, aimed to reduce heterogeneity but at the cost of reduced power, via exclusion of some studies' results of the meta-analysis [37]. Further limitations were included, the conversion of many prognostic factors from continuous to categorical variables, leading to a loss of statistical power and comparison difficulties between studies due to differing thresholds [38,39].…”

Cardiovascular changes in patients with mild‐to‐moderate chronic kidney disease compared with healthy subjects: a 5‐year follow‐up study

“…Established risk factors such as hypertension probably explain much of the increased cardiovascular risk in CKD. Non-traditional risk factors, such as inflammation and disruptions in mineral metabolism, have also been shown to play a role in the increased cardiovascular risks in CKD (Chue et al, 2010;Chue et al, 2012;Major et al, 2018). Non-traditional risk factors, such as inflammation and disruptions in mineral metabolism, have also been shown to play a role in the increased cardiovascular risks in CKD (Chue et al, 2010;Chue et al, 2012;Major et al, 2018).…”

“…Although hypertension is associated with renal dysfunction (Rao et al, 2008), more rapid progression of CKD and the development of various cardiovascular comorbidities (Go et al, 2004;Botdorf et al, 2011;Segura & Ruilope, 2011), it is common that blood pressure (BP) is inadequately controlled in CKD patients (Peralta et al, 2005;Lee et al, 2017). Biomarkers including an abnormal ankle-brachial index (ABI), arterial stiffness, increased common carotid artery (CCA) diameter and intima-media thickness (CIMT), and left ventricular hypertrophy (LVH) are associated with increased cardiovascular risks and worse prognosis in CKD (Szeto et al, 2007;Chue et al, 2010;Paoletti et al, 2011;Karras et al, 2012;Kozakova et al, 2017;Chen et al, 2017;Major et al, 2018). Biomarkers including an abnormal ankle-brachial index (ABI), arterial stiffness, increased common carotid artery (CCA) diameter and intima-media thickness (CIMT), and left ventricular hypertrophy (LVH) are associated with increased cardiovascular risks and worse prognosis in CKD (Szeto et al, 2007;Chue et al, 2010;Paoletti et al, 2011;Karras et al, 2012;Kozakova et al, 2017;Chen et al, 2017;Major et al, 2018).…”

“…Non-traditional risk factors, such as inflammation and disruptions in mineral metabolism, have also been shown to play a role in the increased cardiovascular risks in CKD (Chue et al, 2010;Chue et al, 2012;Major et al, 2018). Biomarkers including an abnormal ankle-brachial index (ABI), arterial stiffness, increased common carotid artery (CCA) diameter and intima-media thickness (CIMT), and left ventricular hypertrophy (LVH) are associated with increased cardiovascular risks and worse prognosis in CKD (Szeto et al, 2007;Chue et al, 2010;Paoletti et al, 2011;Karras et al, 2012;Kozakova et al, 2017;Chen et al, 2017;Major et al, 2018). Several longitudinal studies have evaluated the progression of biomarkers of cardiovascular risk in end-stage renal disease (Foley et al, 2000;Utescu et al, 2013), but few have focused on mildto-moderate CKD.…”

TRAIL, OPG, and TWEAK in kidney disease: biomarkers or therapeutic targets?

“…CKD and CVD are often associated with co-existing pathologies that can begin, intensify and sustain each other [201,202]. CKD patients are at risk of developing CVD proportionally to the severity of kidney disease, decrease in glomerular filtration rate and increase in proteinuria [203]. As a consequence, CKD patients have an early onset and a higher risk of CVD, including stroke, coronary artery disease, peripheral vascular disease, and congestive heart failure, as compared with the general population [202].…”