Coronary Artery Disease Is a Predictor of Progression to Dialysis in Patients With Chronic Kidney Disease, Type 2 Diabetes Mellitus, and Anemia: An Analysis of the Trial to Reduce Cardiovascular Events With Aranesp Therapy (TREAT)

Abstract

BackgroundAlthough clear evidence shows that chronic kidney disease is a predictor of cardiovascular events, death, and accelerated coronary artery disease (CAD) progression, it remains unknown whether CAD is a predictor of progression of chronic kidney disease to end‐stage renal disease. We sought to assess whether CAD adds prognostic information to established predictors of progression to dialysis in patients with chronic kidney disease, diabetes, and anemia.Methods and ResultsUsing the previously described Trial to Reduce Cardiovascular Events With Aranesp Therapy (TREAT) population, we compared baseline characteristics of patients with and without CAD. Cox proportional hazards models were used to assess the association between CAD and the outcomes of end‐stage renal disease and the composite of death or end‐stage renal disease. Of the 4038 patients, 1791 had a history of known CAD. These patients were older (mean age 70 versus 65 years, P<0.001) and more likely to have other cardiovascular disease. CAD patients were less likely to have marked proteinuria (29% versus 39%, P<0.001), but there was no significant difference in estimated glomerular filtration rate between the 2 groups. After adjusting for age, sex, race, estimated glomerular filtration rate, proteinuria, treatment group, and 14 other renal risk factors, patients with CAD were significantly more likely to progress to end‐stage renal disease (adjusted hazard ratio 1.20 [95% CI 1.01–1.42], P=0.04) and to have the composite of death or end‐stage renal disease (adjusted hazard ratio 1.15 [95% CI 1.01–1.30], P=0.03).ConclusionsIn patients with chronic kidney disease, diabetes, and anemia, a history of CAD is an independent predictor of progression to dialysis. In patients with diabetic nephropathy, a history of CAD contributes important prognostic information to traditional risk factors for worsening renal disease.

Janus Face of Coronary Artery Disease and Chronic Kidney Disease

“…Sabe et al also found that CAD was independently associated with death in TREAT study participants 7. Study of prevalent cohorts of Medicare enrollees from 1996 to 2000 showed that those with CKD are 5 to 10 times more likely to die before reaching ESRD than the non‐CKD group 15.…”

“…6 In the present study, Sabe et al noted that those with CAD were less likely to have proteinuria, but the eGFR was not significantly different between those with and without CAD, which could not be explained by use of angiotensin-converting enzyme inhibitor or angiotensin receptor blockers. 7 Traditionally, diabetic nephropathy is described as a chronic progressive disorder that is characterized by microalbuminuria, followed by macroalbuminuria, and hypertension leading to progressive loss of eGFR resulting in ESRD. Recently, several epidemiological studies have shown that frequently T2DM patients with reduced eGFR have no proteinuria.…”

“…11 In this study, Sabe et al tested this possibility by including a time-varying covariate for coronary revascularization in the model and did not find any significant impact on CKD progression, but this secondary analysis of TREAT cannot completely exclude the possibility that AKI could have contributed to the risk of ESRD in this population. 7 Atherosclerosis is an indolent, fibroproliferative disease fueled by chronic inflammation. Immune cells dominate the atherosclerotic lesion and exhibit evidence of activation.…”

Peter Theodore Ivanovich (1928‐2019)

“…Main topics were the investigation of diabetic patients [8][9][10] and optimized dosage of erythropoietin. 2,[11][12][13] Last but not least, it is important to note that Peter has held numerous positions in national and international societies reflecting again his conviction to promote mutual international understanding and involvement of the global dialysis industry. The International Society for Artificial Organs (ISAO) elected him Secretary General of the 5th World Congress in 1985 and Secretary Treasurer in 1990.…”

“…In order to promote high quality treatment options together with patient satisfaction, Peter’s interest and curiosity further stimulated him to be involved in clinical trials even after his formal retirement from his position as professor in medicine at Northwestern University in Chicago. Main topics were the investigation of diabetic patients and optimized dosage of erythropoietin …”