Cardiovascular Determinants of Mortality in Advanced Chronic Kidney Disease

Abstract

Background: Patients with advanced chronic kidney disease (CKD stage 4-5) have an increased risk of death. To study the determinants of all-cause mortality, we recruited 210 consecutive CKD stage 4-5 patients not on dialysis to the prospective Chronic Arterial Disease, quality of life and mortality in chronic KIDney injury (CADKID) study. Methods: One hundred seventy-four patients underwent maximal bicycle ergometry stress testing and lateral lumbar radiography to study abdominal aortic calcification score and echocardiography. Carotid and femoral artery intima-media thickness and elasticity and brachial artery flow-mediated dilatation were measured in 156 patients. Results: The duration of follow-up was 42 ± 17 months (range 134-2,217 days). The mean age was 61 ± 14 years, and the estimated glomerular filtration rate was 12 (11-15) mL/min/1.73 m 2. Thirty-six (21%) patients died during follow-up (time to death 835 ± 372 days). Seventy-five and 21 patients had diabetes and coronary artery disease, respectively, and all but one had hypertension. In the respective multivariate proportional hazards models adjusted for age, sex, and coronary artery disease, the significant determinants of mortality were troponin T, N-terminal pro-B-type natriuretic peptide, maximal ergometry performance, abdominal aortic calcification score, E/e′ ratio, and albumin. Conclusion: Stress ergometry performance, abdominal aortic calcification score, E/e′ of echocardiography, and plasma cardiac biomarkers and albumin predict mortality in advanced CKD.

Maximal Exercise Capacity in Chronic Kidney Disease Stage 4–5 Patients Transitioning to Renal Replacement Therapy or Continuing Conservative Care: A Longitudinal Follow-Up Study

“…In line with this reasoning, it is plausible that MEC did not decline significantly in the dialysis group as these highly comorbid patients are the frailest of CKD patients with the poorest baseline exercise tolerance and, thus, have the least MEC “in reserve” to lose. The association between mortality and impaired MEC has been shown in several studies on different subsets of CKD patients as well as in our previous work [1-3, 18]. Although exercise training has been demonstrated to improve MEC in CKD patients with and without RRT, data are inconsistent whether ameliorated MEC through physical training improves survival [17, 19-21].…”

Progression of Aortic Calcification in Stage 4–5 Chronic Kidney Disease Patients Transitioning to Dialysis and Transplantation

“…The eGFR at AAC2 assessment was 13 ± 6 mL/min/1.73 m 2 in the conservative treatment group. In those who started HD or PD, the median time from dialysis initiation to AAC2 imaging was 19 (15-27) months, and in transplanted patients, the time from transplantation was 14 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) months. In the kidney transplant recipients, eGFR was 60 ± 23 mL/min/1.73 m 2 at the time of the AAC2 imaging.…”

“…The study population target was set to a minimum of 200 patients in the beginning of the recruitment. CADKID is an ongoing, prospective, follow-up study assessing arterial disease, quality of life, mortality, and their predictors in patients with CKD (CKD-KDIGO 4-5) (http://www.Clinical-Trials.gov NCT04223726) [12]. CKD stage 4-5 patients are followed up regularly at 1-to 2-month intervals at the Kidney Centre Predialysis Outpatient Clinic.…”

“…At least one AAC measurement was available in 199 patients, and 150 patients had 2 consecutive AAC measurements and comprised the study cohort. The CADKID study baseline imaging data including baseline AAC measurements have been previously published [12]. Laboratory variables including blood hemoglobin, leukocytes, thrombocytes, glycated hemoglobin, pH, bicarbonate and base excess, plasma C-reactive protein, glucose, alanine aminotransferase, alkaline phosphatase, creatinine, urea, albumin, sodium, potassium, phosphorus, total and ionized calcium and parathyroid hormone (PTH), and serum lipids were collected and recorded every 3 months from the beginning of the study spanning to the second AAC imaging in every patient.…”

Dental health assessed using panoramic radiograph and adverse events in chronic kidney disease stage 4–5 patients transitioning to dialysis and transplantation–A prospective cohort study

“…Univariate associations between DPR findings and outcomes [all-cause mortality, cardiovascular mortality, MACE and bacteremia] were studied using Cox proportional hazards models. Demographic variables known to be associated with mortality in the CADKID study cohort, namely age, diabetes and coronary artery disease [ 15 ] were included in the multivariable Cox proportional hazards models in addition to PTI. As the number of mortality events during follow-up was 36 and number of MACEs was 42, the number of covariates included in the first multivariable Cox model was limited to four to avoid overfitting.…”