Cardiovascular mortality in patients with advanced chronic kidney disease with and without diabetes: a nationwide cohort study

Abstract

Background Cardiovascular mortality and the impact of cardiac risk factors in advanced chronic kidney disease (CKD) remain poorly investigated. We examined the risk of cardiovascular mortality in patients with advanced CKD with and without diabetes as well as the impact of albuminuria, plasma hemoglobin, and plasma low-density lipoprotein (LDL) cholesterol levels. Methods In a Danish nationwide registry-based cohort study, we identified persons aged ≥ 18 years with an estimated glomerular filtration rate < 30 mL/min/1.73m2 between 2002 and 2018. Patients with advanced CKD were age- and sex-matched with four individuals from the general Danish population. Cause-specific Cox regression models were used to estimate the 1-year risk of cardiovascular mortality standardized to the distribution of risk factors in the cohort. Results We included 138,583 patients with advanced CKD of whom 32,698 had diabetes. The standardized 1-year risk of cardiovascular mortality was 9.8% (95% CI 9.6–10.0) and 7.4% (95% CI 7.3–7.5) for patients with and without diabetes, respectively, versus 3.1% (95% CI 3.1–3.1) in the matched cohort. 1-year cardiovascular mortality risks were 1.1- to 2.8-fold higher for patients with diabetes compared with those without diabetes across the range of advanced CKD stages and age groups. Albuminuria and anemia were associated with increased cardiovascular mortality risk regardless of diabetes status. LDL-cholesterol was inversely associated with cardiovascular mortality risk in patients without diabetes, while there was no clear association in patients with diabetes. Conclusions Diabetes, albuminuria, and anemia remained important risk factors of cardiovascular mortality whereas our data suggest a limitation of LDL-cholesterol as a predictor of cardiovascular mortality in advanced CKD.

Association of systemic immune-inflammation index and systemic inflammation response index with chronic kidney disease: observational study of 40,937 adults

“…In addition, we observed that SII and SIRI levels were associated with mortality in patients with different underlying diseases, including diabetes, hypertension, and CVD. The results of our analysis are consistent with previous studies: diabetes is a signi cant risk factor for cardiovascular death and death from hypertension [36,37]. Previous studies have described several potential pathways of glycemic status that lead to effects on vascular outcomes associated with oxidative stress, late glycosylation processes, and epigenetic mechanisms, which in turn affect mortality in patients with CKD [38,39].…”

Patients with hypertension and chronic kidney disease as a priority group for primary prevention programs

“…По результатам датского регистра стандартизированный риск общей и сердечнососудистой смертности пациентов с ХБП в течение 1 года зависит от тяжести заболевания (рис. 5) [9].…”

Linking artificial sweetener intake with kidney function: insights from NHANES 2003–2006 and findings from Mendelian randomization research

“…CKD is characterized by a severe decline in kidney function, reduced glomerular filtration rate (GFR), heightened urinary albumin excretion (proteinuria), and confirmed by two or more diagnoses at least 3 months apart ( 5 ). The condition is closely associated with various comorbidities, including diabetes ( 6 , 7 ), hypertension ( 8 , 9 ), obesity ( 10 , 11 ), particularly cardiovascular diseases ( 12 ), and is strongly correlated with an increased all-cause mortality rate ( 13 , 14 ). Beyond significantly impacting patients’ quality of life, CKD also stands as a major contributor to poverty.…”