Chronic Kidney Disease and the Risk for Cardiovascular Disease, Renal Replacement, and Death in the United States Medicare Population, 1998 to 1999

Foley, Robert N.; Murray, Anne M.; Li, Shuling; Herzog, Charles A.; McBean, A. Marshall; Eggers, Paul W.; Collins, Allan J.

doi:10.1681/asn.2004030203

Cited by 868 publications

(675 citation statements)

References 23 publications

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“…For example, atorvastatin and rosuvastatin failed to reduce risk for CVD events in hemodialysis patients with and without diabetes in Die Deutsche Diabetes Dialyse Studie (4D Study) and A study to evaluate the Use of Rosuvastatin in subjects On Regular hemodialysis: an Assessment of survival and cardiovascular events (AURORA), unusually "negative" statin studies (21,22). Moreover, adverse CVD events in CKD are often due to heart failure, which may be related to higher serum phosphorus, at least in part because of its effect to promote cardiac valvular and muscle calcification (7,15,23,24). Clinical trials of phosphate reduction have been limited by selection of only participants with ESRD and insufficient clinical outcomes data to draw firm conclusions (25,26).…”

Section: Discussionmentioning

confidence: 99%

Longitudinal Relationships among Coronary Artery Calcification, Serum Phosphorus, and Kidney Function

Tuttle

Short

2009

Clinical Journal of the American Society of Nephrology

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Background and objectives: Coronary artery calcification (CAC) is common in advanced chronic kidney disease (CKD), yet its onset and time course are uncertain. The study objective was to assess longitudinal relationships among CAC, kidney function, and traditional and putative cardiovascular disease (CVD) risk factors.Design, setting, participants, & measurements: This is a prospective cohort analysis from the Spokane Heart Study, a long-term observational study of community-dwelling adults who were assessed every 2 yr for CAC (electron-beam computed tomography), CVD risk factors, and laboratory testing. Estimated GFR (eGFR) was determined by the reexpressed Modification of Diet in Renal Disease equation.Results: CAC was present in 28% (245 of 883) at baseline. After 6 yr, new-onset CAC developed in 33% (122 of 371); severity increased from a median CAC score of 38 to 152 in those with baseline CAC. Neither eGFR (101 ؎ 34 versus 104 ؎ 31 ml/min per 1.73 m 2 , respectively) nor serum phosphorus (3.25 ؎ 0.49 versus 3.29 ؎ 0.48 mg/dl, respectively) differed by CAC presence or absence at baseline; however, multivariate models (generalized estimating equations for incidence and prevalence) revealed that independent predictors of CAC over time were greater baseline CAC scores, higher serum phosphorus levels, lower eGFR levels, and traditional CVD risk factors. Each 1-mg/dl increase in phosphorus imparted odds ratios for CAC of 1.61 (incidence) and 1.54 (prevalence), risks comparable to traditional CVD risk factors.Conclusions: CAC becomes more frequent and severe over time. Higher levels of serum phosphorus and reduced kidney function independently predicted CAC.

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Section: Discussionmentioning

confidence: 99%

Longitudinal Relationships among Coronary Artery Calcification, Serum Phosphorus, and Kidney Function

Tuttle

Short

2009

Clinical Journal of the American Society of Nephrology

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“…People who develop ESKD have survived a period of chronic kidney disease and other competing risks of death-if these risks were higher among type 2 diabetic than non-diabetic patients, a bias may be introduced. Differences in the prevalence of CVD and the associated mortality between patients with ESKD and the general population by diabetes status are likely to exist: in the US Medicare population aged ≥65 years, the prevalence of peripheral vascular disease was 3.4-fold higher in nondiabetic patients with chronic kidney disease (CKD) than in those without CKD (32.0% vs 9.6%) but was only 2.1-fold higher in diabetic patients with CKD than in those without CKD (38.6% vs 18.0%) [8]. This may confound the diabetes association.…”

Section: Discussionmentioning

confidence: 99%

Effect of type 2 diabetes on mortality risk associated with end-stage kidney disease

et al. 2009

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Aims/hypothesis Patients with end-stage kidney disease (ESKD) and patients with diabetes mellitus experience higher mortality rates than the general population. Whether ESKD imparts the same excess in mortality risk for those with diabetes as it does for those without diabetes is unknown. Methods Included in the study were all white patients aged ≥25 years with incident ESKD and type 2 diabetes (n=4,141) or with incident ESKD but without diabetes (n=13,289) in Australia from 1991 to 2005, and all the individuals aged ≥25 years without ESKD and with type 2 diabetes (n= 909) or without ESKD without diabetes (n=10,302) enrolled in the AusDiab Study-a nationwide Australian representative cohort-from 1999 to 2005. Excess mortality was analysed in patients with ESKD by diabetes status, using age-, sex-and diabetes-status-specific standardised mortality ratios (SMRs) in the first 8 years after first renal replacement therapy among ANZDATA patients relative to AusDiab participants. Results The SMRs in patients with ESKD were, in nondiabetic patients and in those with type 2 diabetes, respectively: 14.2 (95% CI 13.9-14.6) and 10.8 (95% CI 10.4-11.2) (p<0.01); in people aged <60 years, 28.7 (95% CI 27.2-30.4) and 18.6 (95% CI 17.1-20.4) (p<0.01); in people aged ≥60 years, 12.5 (95% CI 12.1-12.9) vs 9.7 (95% CI 9.3-10.1) (p<0.01); in men, 11.0 (95% CI 10.7-11.4) vs 8.9 (95% CI 8.4-9.3) (p<0.01); and in women, 23.4 (95% CI 22.5-24.3) vs 16.2 (95% CI 15.2-17.3) (p<0.01). Conclusions/interpretation ESKD was associated with a greater relative increase in mortality in the non-diabetic study populations than in the type 2 diabetes population. Excess mortality was greater among younger people and women.

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“…22 An established algorithm was used to identify stroke/transient ischemic attack. 23 Elixhauser algorithms 24 were utilized to identify depression, other neurologic disorders, collagen vascular disease, and solid tumors (without metastasis); other published algorithms were used to identify hyperlipidemia, 25 chronic kidney disease, 26 eye disease, 27 congestive heart failure, 25 peripheral vascular disease, 27 and dementia. 28 Due to low prevalence, comorbidities were categorized into the following categories for analysis: microvascular disease (chronic kidney disease and/or eye disease), noncardiac cerebrovascular complications (stroke/transient ischemic attack and/or other neurologic conditions), ischemic heart disease/congestive heart failure (congestive heart failure and/or ischemic heart disease), and other comorbidities (dementia, collagen vascular disease, and/or malignancy).…”

Section: Explanatory Variablesmentioning

confidence: 99%

Diagnosis and Treatment of Incident Hypertension Among Patients with Diabetes: a U.S. Multi-Disciplinary Group Practice Observational Study

et al. 2015

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BACKGROUND: Early hypertension control reduces the risk of cardiovascular complications among patients with diabetes mellitus. There is a need to improve hypertension management among patients with diabetes mellitus. OBJECTIVE: We aimed to evaluate rates and associations of hypertension diagnosis and treatment among patients with diabetes mellitus and incident hypertension. DESIGN: This was a 4-year retrospective analysis of electronic health records. PARTICIPANTS: Adults ≥18 years old (n=771) with diabetes mellitus, who met criteria for incident hypertension and received primary care at a large, Midwestern academic group practice from 2008 to 2011 were included MAIN MEASURES: Cut-points of 130/80 and 140/ 90 mmHg were used to identify incident cases of hypertension. Kaplan-Meier analysis estimated the probability of receiving: 1) an initial hypertension diagnosis and 2) antihypertensive medication at specific time points. Cox proportional-hazard frailty models (HR; 95 % CI) were fit to identify associations of time to hypertension diagnosis and treatment. KEY RESULTS: Among patients with diabetes mellitus who met clinical criteria for hypertension, 41 % received a diagnosis and 37 % received medication using the 130/ 80 mmHg cut-point. At the 140/90 mmHg cut-point, 52 % received a diagnosis and 49 % received medication. Atrial fibrillation (HR 2.18; 1.21-4.67) was associated with faster diagnosis rates; peripheral vascular disease (HR 0.18; 0.04-0.74) and fewer primary care visits (HR 0.93; 0.88-0.98) were associated with slower diagnosis rates. Atrial fibrillation (HR 3.07; 1.39-6.74) and ischemic heart disease/congestive heart failure (HR 2.16; 1.24-3.76) were associated with faster treatment rates; peripheral vascular disease (HR 0.16;) and fewer visits (HR 0.93;) predicted slower medication initiation. Diagnosis and treatment of incident hypertension were similar using cut-points of 130/80 and 140/90 mmHg. CONCLUSIONS: Among patients with diabetes mellitus, even using a cut-point of 140/90 mmHg, approximately 50 % remained undiagnosed and untreated for hypertension. Future interventions should target patients with multiple comorbidities to improve hypertension and diabetes clinical care.

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Chronic Kidney Disease and the Risk for Cardiovascular Disease, Renal Replacement, and Death in the United States Medicare Population, 1998 to 1999

Cited by 868 publications

References 23 publications

Longitudinal Relationships among Coronary Artery Calcification, Serum Phosphorus, and Kidney Function

Longitudinal Relationships among Coronary Artery Calcification, Serum Phosphorus, and Kidney Function

Effect of type 2 diabetes on mortality risk associated with end-stage kidney disease

Diagnosis and Treatment of Incident Hypertension Among Patients with Diabetes: a U.S. Multi-Disciplinary Group Practice Observational Study

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