Evaluation of cardiovascular disease burden and therapeutic goal attainment in US adults with chronic kidney disease: an analysis of national health and nutritional examination survey data, 2001–2010

Abstract

BackgroundFor chronic kidney disease (CKD) patients, national treatment guidelines recommend a low-density lipoprotein cholesterol (LDL-C) goal <100 mg/dL and blood pressure (BP) target <130/80 mmHg. This analysis assessed the current status of cardiovascular (CV) risk factor treatment and control in US adults with CKD.MethodsWeighted prevalence estimates of CV-related comorbidities, utilization of lipid- and BP-lowering agents, and LDL-C and BP goal attainment in US adults with CKD were assessed among 9,915 men and nonpregnant women aged ≥20 years identified from the fasting subsample of the 2001–2010 National Health and Nutritional Examination Survey (NHANES). Analyses were performed using SAS survey procedures that consider the complex, multistage, probability sampling design of NHANES. All estimates were standardized to the 2008 US adult population (≥20 years). Data were stratified by CKD stage based on presence of albuminuria and estimated glomerular filtration rate (eGFR), calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Stage 3 CKD was subdivided into 3a (eGFR 45–59 mL/min/1.73 m2) and 3b (eGFR 30–44 mL/min/1.73 m2); Stage 5 CKD and dialysis recipients were excluded.ResultsOf the 9,915 NHANES participants identified for analysis, 1,428 had CKD (Stage 1–4), corresponding to a prevalence estimate for US adults aged ≥20 years of 10.2%. Prevalence of CV-related comorbidities increased markedly with CKD stage, with a ~6–12-fold increase in cardiovascular disease, coronary heart disease (CHD), stroke and congestive heart failure between CKD Stage 1 and 4; prevalence of diabetes, hyperlipidemia and hypertension increased by ~1.2–1.6-fold. Use of lipid-lowering agents increased with CKD stage, from 18.1% (Stage 1) to 44.8% (Stage 4). LDL-C goal attainment increased from 35.8% (Stage 1) to 52.8% (Stage 3b), but decreased in Stage 4 (50.7%). BP goal attainment decreased between Stage 1 and 4 (from 49.5% to 30.2%), despite increased use of antihypertensives (from 30.2% to 78.9%).ConclusionsIndividuals with CKD have a high prevalence of CV-related comorbidities. However, attainment of LDL-C or BP goals was low regardless of disease stage. These findings highlight the potential for intensive risk factor modification to maximize CV event reduction in CKD patients at high risk for CHD.

Prevalence and Correlates of CKD in Hispanics/Latinos in the United States

“…Furthermore, we found a prevalence of current smoking of 21%, which is concerning given the known association between smoking and adverse CKD outcomes such as progression to ESRD, cardiovascular events, and death (18). Interestingly, mean LDL cholesterol was 120 mg/dl, which is higher than that reported among 2001-2010 NHANES participants with CKD (111 mg/dl) and without CKD (117 mg/dl) (19). Despite the presence of multiple cardiovascular risk factors, only 20% of individuals with CKD were prescribed either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker, medications that are known to decrease CKD progression risk (20).…”

AKI on CKD: heightened injury, suppressed repair, and the underlying mechanisms

“…Such loss of renal function leads to the accumulation of multiple pathogenic factors, such as uremic toxins, oxidized proteins, and advanced glycation end products (AGE), to name just a few 182–186 . Those injurious factors are delivered through blood to all over the body to cause further peripheral vasculature damage and major cardiovascular defects, which may directly decrease blood support to kidneys to induce ischemic AKI 28, 187, 188 .…”

Development of a Formula for Estimation of Sodium Intake from Spot Urine in People with Chronic Kidney Disease

“…Hypertension, which is thought to be predominately salt sensitive [2], is common with estimates of prevalence up to 92% in those with CKD stage 3 [3,4,5]. …”