Clinical factors for predicting cardiovascular risk, need for renal replacement therapy, and mortality in patients with non–dialysis-dependent stage 3–5 chronic kidney disease from the Salford Kidney Study

Abstract

Background Established cardiovascular risk assessment tools lack chronic kidney disease–specific clinical factors and may underestimate cardiovascular risk in non–dialysis-dependent chronic kidney disease (CKD) patients. Methods A retrospective analysis of a cohort of patients with stage 3–5 non–dialysis-dependent chronic kidney disease in the Salford Kidney Study (UK, 2002–2016) was performed. Multivariable Cox regression models with backward selection and repeated measures joint models were used to evaluate clinical risk factors associated with cardiovascular events (individual and composite cardiovascular major adverse cardiovascular events), mortality (all-cause and cardiovascular-specific), and need for renal replacement therapy. Models were established using 70% of the cohort and validated on the remaining 30%. Hazard ratios ([95% CIs]) were reported. Results Among 2192 patients, mean follow-up was 5.6 years. Cardiovascular major adverse cardiovascular events occurred in 422 (19.3%) patients; predictors included prior history of diabetes (1.39 [1.13–1.71]; P = 0.002) and serum albumin reduction of 5 g/L (1.20 [1.05–1.36]; P = 0.006). All-cause mortality occurred in 740 (33.4%) patients, median time to death was 3.8 years; predictors included reduction of estimated glomerular filtration of 5 mL/min/1.73 m2 (1.05 [1.01–1.08]; P = 0.011) and increase of phosphate of 0.1 mmol/L (1.04 [1.01–1.08]; P = 0.021), whereas a 10 g/L hemoglobin increase was protective (0.90 [0.85–0.95]; P < 0.001). In 394 (18.0%) patients who received renal replacement therapy, median time to event was 2.3 years; predictors included halving of estimated glomerular filtration rate (3.40 [2.65–4.35]; P < 0.001) and antihypertensive use (1.23 [1.12–1.34]; P < 0.001). Increasing age, albumin reduction, and prior history of diabetes or cardiovascular disease were risk factors for all outcomes except renal replacement therapy. Conclusions Several chronic kidney disease–specific cardiovascular risk factors were associated with increased mortality and cardiovascular event risk in patients with non–dialysis-dependent chronic kidney disease. Graphical abstract

Sevelamer Use and Mortality in People with Chronic Kidney Disease Stages 4 and 5 Not on Dialysis

“…In the PECERA study, treatment with sevelamer was associated with lower all-cause and cardiovascular mortality in Spanish stage 4-5 NDD-CKD patients. The better survival rate was observed despite higher percentages of stage 5 CKD, higher serum levels of Ca alb , phosphate and PTH, and lower eGFR and albumin levels, factors that have all been associated with higher mortality risk in NDD-CKD [1,[3][4][5][6][7][25][26][27][28]. Conversely, other factors related to lower mortality risk, such as lower levels of CRP and more use of vitamin D compounds, were also observed in the sevelamer-treated group [26,29,30].…”

Conservative Management in End-Stage Kidney Disease between the Dialysis Myth and Neglected Evidence-Based Medicine

“…Secondly, a close collaboration with a dietician or dietologist is mandatory, considering that a low protein diet is a prerequisite of CM. An adequate diet allows us to have better control of the metabolic issues related to CKD [ 42 ] and theoretically positively impacts non-traditional CV risk factors such as anemia [ 50 , 51 ], potassium imbalance [ 51 ], and phosphate imbalance [ 51 ]. A good interaction between dietary knowledge and nephrologist skills is the best answer for ESKD to improve urea retention, calciumphosphorous metabolism, metabolic acidosis, electrolyte impairment, malnutrition, and muscle mass loss.…”