Epidemiological evaluation of known and suspected cardiovascular risk factors in chronic renal impairment

Landray, Martin J; Thambyrajah, Jeetendra; McGlynn, Fiona J; Jones, H.; Baigent, Colin; Kendall, M. J.; Townend, Jonathan N.; Wheeler, David C.

doi:10.1053/ajkd.2001.26850

Cited by 95 publications

(51 citation statements)

References 24 publications

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“…Details of the design and methods of the Chronic Renal Impairment in Birmingham (CRIB) study have been described previously (15)(16)(17) and are summarized below.…”

Section: Methodsmentioning

confidence: 99%

Serum Free Light Chains and the Risk of ESRD and Death in CKD

Haynes

Hutchison

Emberson

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Associations between inflammation and ESRD and death in chronic kidney disease are well established. However, the potential role of the adaptive immune system is uncertain. We aimed to prospectively study the relevance of the adaptive immune system to ESRD and mortality by measuring monoclonal and polyclonal excesses of highly sensitive serum free light chains (sFLCs).Design, setting, participants, & measurements Three hundred sixty-four patients selected from a nephrology outpatient clinic had kappa and lambda sFLCs concentrations and serum immunofixation electrophoresis measured. Cox regression was used to assess the relevance of monoclonal and polyclonal excess of sFLCs to the incidence of ESRD and death (mean follow-up for death 6.0 years). ResultsAfter adjustment for baseline eGFR, there was no significant association between monoclonal excess of sFLCs and risk of ESRD or mortality. Baseline log and log concentrations were positively associated with ESRD risk, but these associations seemed to be due to correlations with eGFR (per 1 SD higher concentration: adjusted hazard ratio 1.05 [95% confidence interval 0.88 to 1.26] and 0.99 [0.83 to 1.19], respectively). For mortality, after adjustment for eGFR plus markers of cardiac damage, there was weak evidence of an association with , but not , sFLC concentration (fully adjusted hazard ratio 1.33 [95% confidence interval 1.05 to 1.67] per 1 SD higher concentration). ConclusionsAssociations between monoclonal and polyclonal excess of sFLCs and risk of ESRD are explained by the correlation between these measures and renal function. We found only weak evidence of an association between polyclonal excess of sFLC concentration and mortality.

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“…Details of the design and methods of the Chronic Renal Impairment in Birmingham (CRIB) study have been described previously (15)(16)(17) and are summarized below.…”

Section: Methodsmentioning

confidence: 99%

Serum Free Light Chains and the Risk of ESRD and Death in CKD

Haynes

Hutchison

Emberson

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…It is likely that the interplay between CKD and cardiovascular disease risk factors, includ- ing diabetes, hypertension, anemia, and inflammation, leads to enhanced cardiovascular risk. 38,39 In the most recent hypertension guidelines, the National Kidney Foundation and the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure have classified CKD as a cardiovascular disease risk equivalent. 40 We concur that patients with CKD should be risk-stratified on initial contact and should receive aggressive medical management for cardiac risk factors.…”

Section: Declining Renal Function and Adverse Events: Ckd As Cad Riskmentioning

confidence: 99%

Predictive Value of Myocardial Perfusion Single-Photon Emission Computed Tomography and the Impact of Renal Function on Cardiac Death

et al. 2008

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Background-Patients with chronic kidney disease (CKD) have worse cardiovascular outcomes than those without CKD. The prognostic utility of myocardial perfusion single-photon emission CT (MPS) in patients with varying degrees of renal dysfunction and the impact of CKD on cardiac death prediction in patients undergoing MPS have not been investigated. Methods and Results-We followed up 1652 consecutive patients who underwent stress MPS (32% exercise, 95% gated) for cardiac death for a mean of 2.15Ϯ0.8 years. MPS defects were defined with a summed stress score (normal summed stress score Ͻ4, abnormal summed stress scoreՆ4). Ischemia was defined as a summed stress score Ն4 plus a summed difference score Ն2, and scar was defined as a summed difference score Ͻ2 plus a summed stress score Ն4. Renal function was calculated with the Modified Diet in Renal Disease equation. CKD (estimated glomerular filtration rate Ͻ60 mL · min Ϫ1 · 1.73 m Ϫ2 ) was present in 36%. Cardiac death increased with worsening levels of perfusion defects across the entire spectrum of renal function. Presence of ischemia was independently predictive of cardiac death, all-cause mortality, and nonfatal myocardial infarction. Patients with normal MPS and CKD had higher unadjusted cardiac death event rates than those with no CKD and normal MPS (2.7% versus 0.8%, Pϭ0.001). Multivariate Cox proportional hazards models revealed that both perfusion defects (hazard ratio 1.90, 95% CI 1.47 to 2.46) and CKD (hazard ratio 1.96, 95% CI 1.29 to 2.95) were independent predictors of cardiac death after accounting for risk factors, left ventricular dysfunction, pharmacological stress, and symptom status. Both MPS and CKD had incremental power for cardiac death prediction over baseline risk factors and left ventricular dysfunction (global 2 207.5 versus 169.3, PϽ0.0001). Conclusions-MPS

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“…While the increased risk of complications associated with percutaneous and surgical coronary revascularization in ESRD patients is well known, there are few reports of survival benefits (4). Moreover, it appears that CAD is a relatively minor component of the accelerated CVD that affects patients with ESRD; the excess of CVD appears to be due to sudden death, probably arrhythmic in origin and related to 'uremic' cardiomyopathy (5,6). The assessment of patients awaiting transplantation is further complicated by difficulties in the use of noninvasive cardiac screening tests that are limited by combination of a high prevalence of CV abnormalities in this population as well as by poor exercise capacity in patients with ESRD.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Value of Cardiovascular Screening in Potential Renal Transplant Recipients: Single-Center Prospective Observational Study

Patel

Mark

Johnston

et al. 2008

American Journal of Transplantation

109

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We assessed the outcome of pretransplant cardiac assessment in a single center. Three hundred patients with end-stage renal disease underwent electrocardiogram, Bruce exercise testing (ETT) and ventricular assessment by cardiac MRI. Patients with high index of suspicion of coronary artery disease (CAD) underwent coronary angiography and percutaneous coronary intervention (PCI) if indicated. Two hundred and twentytwo patients were accepted onto the renal transplant waiting list; 80 patients were transplanted during the follow-up period and 60 died (7 following transplantation). Successful transplantation was associated with improved survival (mean survival 4.5 ± 0.6 years vs. listed not transplanted 4.1 ± 1.4 years vs. not listed 3.1 ± 1.7 years; p < 0.001). Ninety-nine patients underwent coronary angiography; 65 had normal or lowgrade CAD and 34 obstructive CAD. Seventeen patients (5.6%) were treated by PCI. There was no apparent survival difference between patients who underwent PCI or coronary artery bypass graft compared to those who underwent angiography without intervention or no angiography (p = 0.67). Factors associated with nonlisting for renal transplantation included burden of preexisting cardiovascular disease, poor exercise tolerance and severity of CAD. Pretransplant cardiovascular screening provides prognostic information and information that can be used to restrict access to transplantation. However, if the aim is to identify and treat CAD, the benefits are far from clear.

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Epidemiological evaluation of known and suspected cardiovascular risk factors in chronic renal impairment

Cited by 95 publications

References 24 publications

Serum Free Light Chains and the Risk of ESRD and Death in CKD

Serum Free Light Chains and the Risk of ESRD and Death in CKD

Predictive Value of Myocardial Perfusion Single-Photon Emission Computed Tomography and the Impact of Renal Function on Cardiac Death

Prognostic Value of Cardiovascular Screening in Potential Renal Transplant Recipients: Single-Center Prospective Observational Study

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