Incremental prognostic value of kidney function decline over coronary artery disease for cardiovascular event prediction after coronary computed tomography

Bittencourt, Márcio Sommer; Hulten, Edward; Ghoshhajra, Brian B.; Abbara, Suhny; Murthy, Venkatesh L.; Divakaran, Sanjay; Nasir, Khurram; Gowdak, Luís Henrique Wolff; Riella, Leonardo V.; Chiumiento, Marco; Hoffmann, Udo; Carli, Marcelo F. Di; Blankstein, Ron

doi:10.1038/ki.2014.426

Cited by 17 publications

(10 citation statements)

References 38 publications

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“…Indeed, inconsistent results have been seen regarding whether CKD measures can improve CVD prediction beyond traditional risk factors (Table 1). 7-13 These studies have used different definitions of CKD measures and CVD outcomes and have applied different statistical approaches, making it difficult to infer definite conclusions.…”

Section: Two Key Ckd Measures For Cvd Prediction: Representative Indimentioning

confidence: 99%

Cardiovascular risk prediction in people with chronic kidney disease

Matsushita

Ballew

Coresh

2016

Current Opinion in Nephrology and Hypertension

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Purpose of review Clinical guidelines are not consistent regarding whether or how to utilize information on measures of chronic kidney disease (CKD) for predicting the risk of cardiovascular disease (CVD). This review summarizes recent literature regarding CVD prediction in the context of CKD. Recent findings Previous studies used different definitions of CKD measures and CVD outcomes and applied distinct statistical approaches. A recent individual-level meta-analysis from the CKD Prognosis Consortium is of value since it has uniformly investigated creatinine-based estimated glomerular filtration rate (eGFR) and albuminuria as CKD measures and applied the same statistical approach across 24 cohorts with >630,000 participants. In this meta-analysis, eGFR and albuminuria improve CVD risk prediction beyond traditional CVD risk factors, particularly for CVD mortality and heart failure. Albuminuria demonstrates more evident improvement than eGFR. Moreover, several recent studies have shown that other filtration markers, e.g., cystatin C and β2-microglobulin, and measures of atherosclerosis or cardiac damage (e.g., coronary artery calcium and cardiac troponins) can further improve CVD prediction in CKD population. Summary Future clinical guidelines may require updates regarding whether/how to incorporate CKD measures and other biomarkers in CVD prediction, depending on CVD outcomes of interest, target population, and availability of those measures/biomarkers in that population.

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Section: Two Key Ckd Measures For Cvd Prediction: Representative Indimentioning

confidence: 99%

Cardiovascular risk prediction in people with chronic kidney disease

Matsushita

Ballew

Coresh

2016

Current Opinion in Nephrology and Hypertension

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“…Several previous studies have demonstrated that the major cause of death in non-dialysis-dependent CKD was CVD [ 4 – 6 ]. Meanwhile, some studies have indicated a significant association between severity of CKD assessed by estimated glomerular filtration rate (eGFR) and the risk of CVD in the general population and high-risk population [ 7 – 12 ]. The linkage between kidney dysfunction and CVD risk attracts lots of attention.…”

Section: Introductionmentioning

confidence: 99%

Estimated Glomerular Filtration Rate and Mortality among Patients with Coronary Heart Disease

et al. 2016

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ObjectiveThe association between estimated glomerular filtration rate (eGFR) and the risk of mortality among patients with coronary heart disease (CHD) is complex and still unclear. The aim of this study was to evaluate the effect of eGFR on the risk prediction of all-cause and cardiovascular disease (CVD) mortality with a long follow-up period among patients with CHD in China.MethodsWe conducted a prospective cohort study of 3276 Chinese patients with CHD. Cox proportional hazards regression models were used to estimate the association of different levels of eGFR with the risks of mortality.ResultsDuring a mean follow-up period of 4.9 years, 293 deaths were identified. The multivariable-adjusted hazard ratios associated with different levels of eGFR (≥90 [reference group], 60–89, 30–59, 15–29 ml/min per 1.73m2) at baseline were 1.00, 1.28 (95% confidence interval [CI], 0.87–1.88), 1.96 (95% CI, 1.31–2.94), and 3.91 (95% CI, 2.15–7.13) (P <0.001) for all-cause mortality, and 1.00, 1.26 (95% CI, 0.78–2.04), 1.94 (95% CI, 1.17–3.20), and 3.77 (95% CI, 1.80–7.89) (P <0.001) for CVD mortality, respectively. After excluding subjects who died during the first 2 years of follow-up (n = 113), the graded associations of eGFR with the risks of all-cause and CVD morality were still present. The addition of eGFR to a model including traditional cardiovascular risk factors resulted in significant improvement in the prediction of all-cause and CVD mortality.ConclusionsReduced eGFR (< 60 ml/min per 1.73 m2) at baseline is associated with increased risks of all-cause and CVD mortality among Chinese patients with CHD.

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“…This is of extreme importance, as scarce data about mortality are available regarding patients on dialysis, a population usually excluded from clinical trials. Obstructive CAD accounts for a large proportion of deaths among patients with CKD [13], although is overshadowed by non-atherosclerotic causes of death, particularly in patients on dialysis. The cardiac risk stratification seems to vary according to eGFR and, unfortunately, a population on dialysis is poorly represented.…”

Section: Resultsmentioning

confidence: 99%

Mortality of Patients on Maintenance Hemodialysis Submitted to Coronary Artery Bypass Surgery

et al. 2020

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Background: Patients with chronic kidney disease (CKD) are less likely to be submitted to coronary artery bypass grafting (CABG) then clinical medical treatment based on the potential high risk of mortality. However, whether patients on maintenance dialysis who underwent an elective CABG experience high hospital-and long-term mortality is still debatable. Methods: This is a prospective observational study that evaluated patients who underwent elective CABG. Three groups were compared: reference (n = 167, estimated glomerular filtration rate [eGFR] ≥60 mL/min/1.73 m 2), CKD3-4 (n = 84, eGFR 15-59 mL/min/1.73 m 2), and maintenance hemodialysis (n = 31). Demographic, clinical, biochemical, fluid balance data, and Sequential Organ Failure Assessment (SOFA) scores were assessed daily for the same observer from day 1 (surgery) to hospital discharge. Results: The main outcomes were in-hospital and 1-year mortality. Patients aged 63 ± 10, 63 ± 8, and 65 ± 6 years old, in reference, CKD3-4, and dialysis groups, respectively (p = 0.605). Patients from the reference group had a lower prevalence of diabetes (p = 0.010) and hypertension (p = 0.021). SOFA scores were higher in CKD3-4 and dialysis groups (p = 0.001), though this difference disappeared without the renal component (p = 0.326). In-hospital mortality (n = 17) was similar across groups (p = 0.955). There was no difference in 1-year mortality among groups even after adjustments for age, diabetes, intraoperative blood loss, and time on ventilation. Conclusions: CABG short-term mortality seems not to be greater among selected patients on maintenance dialysis. A multidisciplinary team has been helping cardiologists and cardiac surgeons in the decision-making process regarding the best approach in coronary artery disease, and CABG should be considered a worthy therapeutic option.

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Incremental prognostic value of kidney function decline over coronary artery disease for cardiovascular event prediction after coronary computed tomography

Cited by 17 publications

References 38 publications

Cardiovascular risk prediction in people with chronic kidney disease

Cardiovascular risk prediction in people with chronic kidney disease

Estimated Glomerular Filtration Rate and Mortality among Patients with Coronary Heart Disease

Mortality of Patients on Maintenance Hemodialysis Submitted to Coronary Artery Bypass Surgery

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