Risk of End-Stage Renal Disease and Death After Cardiovascular Events in Chronic Kidney Disease

Sud, Maneesh; Tangri, Navdeep; Pintilie, Melania; Levey, Andrew S.; Naimark, David

doi:10.1161/circulationaha.113.007106

Cited by 68 publications

(61 citation statements)

References 38 publications

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“…21,22 Similarly, episodes of acute coronary syndrome or congestive heart failure may increase the risk of death and also, cause true GFR decline. 23,24 However, we observed similar associations of antecedent eGFR decline with non-CVD mortality as we did with CVD mortality (albeit in the limited cohorts with these data). Previous investigations have suggested that variability in the eGFR itself may be associated with higher ACM risk.…”

Section: Discussionsupporting

confidence: 83%

Past Decline Versus Current eGFR and Subsequent Mortality Risk

Naimark

Grams

Matsushita

et al. 2015

JASN

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A single determination of eGFR associates with subsequent mortality risk. Prior decline in eGFR indicates loss of kidney function, but the relationship to mortality risk is uncertain. We conducted an individual-level meta-analysis of the risk of mortality associated with antecedent eGFR slope, adjusting for established risk factors, including last eGFR, among 1.2 million subjects from 12 CKD and 22 other cohorts within the CKD Prognosis Consortium. Over a 3-year antecedent period, 12% of participants in the CKD cohorts and 11% in the other cohorts had an eGFR slope ,25 ml/min per 1.73 m 2 per year, whereas 7% and 4% had a slope .5 ml/min per 1.73 m 2 per year, respectively. Compared with a slope of 0 ml/min per 1.73 m 2 per year, a slope of 26 ml/min per 1.73 m 2 per year associated with adjusted hazard ratios for all-cause mortality of 1.25 (95% confidence interval [95% CI], 1.09 to 1.44) among CKD cohorts and 1.15 (95% CI, 1.01 to 1.31) among other cohorts during a follow-up of 3.2 years. A slope of +6 ml/min per 1.73 m 2 per year also associated with higher all-cause mortality risk, with adjusted hazard ratios of 1.58 (95% CI, 1.29 to 1.95) among CKD cohorts and 1.43 (95% CI, 1.11 to 1.84) among other cohorts. Results were similar for cardiovascular and noncardiovascular causes of death and stronger for longer antecedent periods (3 versus ,3 years). We conclude that prior decline or rise in eGFR associates with an increased risk of mortality, independent of current eGFR.

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Section: Discussionsupporting

confidence: 83%

Past Decline Versus Current eGFR and Subsequent Mortality Risk

Naimark

Grams

Matsushita

et al. 2015

JASN

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“…Close monitoring and management of comorbid disease is essential for risk reduction in these patients [7,9]. The most common causes of death in our study included cardiac and infectious diseases, which is consistent with the current literature [16,17,18,19]. In addition, metabolic/endocrine disorders and vascular diseases were also a significant cause of mortality in this study [20].…”

Section: Discussionsupporting

confidence: 88%

Mortality after Renal Allograft Failure and Return to Dialysis

Brar

Markell²,

Stefanov³

et al. 2017

Am J Nephrol

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Introduction: The outcomes of patients who fail their kidney transplant and return to dialysis (RTD) has not been investigated in a nationally representative sample. We hypothesized that variations in management of transplant chronic kidney disease stage 5 leading to kidney allograft failure (KAF) and RTD, such as access, nutrition, timing of dialysis, and anemia management predict long-term survival. Methods: We used an incident cohort of patients from the United States Renal Data System who initiated hemodialysis between January 1, 2003 and December 31, 2008, after KAF. We used Cox regression analysis for statistical associations, with mortality as the primary outcome. Results: We identified 5,077 RTD patients and followed them for a mean of 30.9 ± 22.6 months. Adjusting for all possible confounders at the time of RTD, the adjusted hazards ratio (AHR) for death was increased with lack of arteriovenous fistula at initiation of dialysis (AHR 1.22, 95% CI 1.02-1.46, p = 0.03), albumin <3.5 g/dL (AHR 1.33, 95% CI 1.18-1.49, p = 0.0001), and being underweight (AHR 1.30, 95% CI 1.07-1.58, p = 0.006). Hemoglobin <10 g/dL (AHR 0.96, 95% CI 0.86-1.06, p = 0.46), type of insurance, and zip code-based median household income were not associated with higher mortality. Glomerular filtration rate <10 mL/min/1.73 m² at time of dialysis initiation (AHR 0.83, 95% CI 0.75-0.93, p = 0.001) was associated with reduction in mortality. Conclusions: Excess mortality risk observed in patients starting dialysis after KAF is multifactorial, including nutritional issues and vascular access. Adequate preparation of patients with failing kidney transplants prior to resuming dialysis may improve outcomes.

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“…The presence of residual renal function, even at a low level, is associated with a lower mortality risk in hemodialysis patients [8], underlying the impact of kidney function on CV prognosis. Furthermore, the presence of CV disease worsens the short- and long-term prognosis of CKD [8] as shown in a recent large cohort study comprising 2,964 CKD patients, with a follow-up time of 2.76 years, where CV events were associated with a significant increase in the risk of ESRD and all-cause mortality before ESRD [9]. …”

Section: Introductionmentioning

confidence: 99%

Arterial Stiffness and Chronic Kidney Disease

Garnier

Briet²

2015

Pulse

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Chronic kidney disease (CKD) is a major public health concern due to the high prevalence of associated cardiovascular (CV) disease. CV mortality is 10-30 times higher in end-stage renal disease patients than in the age-adjusted general population. The last 20 years have been marked by a huge effort in the characterization of the vascular remodeling process associated with CKD and its consequences on the renal, CV and general prognosis. By comparison with patients with normal renal function, with or without hypertension, an increase in large artery stiffness has been described in end-stage renal disease as well as in CKD stages 2-5. Most clinical studies are consistent with the observation that damage to large arteries may contribute to the high incidence of CV disease. By contrast, the impact of large artery stiffening and remodeling on CKD progression is still a matter of debate. Concomitant exposure to other CV risk factors, including diabetes, seems to play a major role in the association between aortic stiffness and estimated GFR. The conflicting results obtained from longitudinal studies designed to evaluate the impact of baseline aortic stiffness on GFR progression are detailed in the present review. Only pulse pressure, central and peripheral, is almost constantly associated with incident CKD and GFR decline. Kidney transplantation improves patients' CV prognosis, but its impact on arterial stiffness is still controversial. Donor age, living kidney donation and mean blood pressure appear to be the main determinants of improvement in aortic stiffness after kidney transplantation.

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Risk of End-Stage Renal Disease and Death After Cardiovascular Events in Chronic Kidney Disease

Cited by 68 publications

References 38 publications

Past Decline Versus Current eGFR and Subsequent Mortality Risk

Past Decline Versus Current eGFR and Subsequent Mortality Risk

Mortality after Renal Allograft Failure and Return to Dialysis

Arterial Stiffness and Chronic Kidney Disease

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