Impact of CKD Progression on Cardiovascular Disease Risk in a Contemporary UK Cohort of Individuals With Diabetes

Cabrera, Claudia; Lee, Alison S.; Olsson, Marita; Schnecke, Volker; Westman, Klara; Lind, Marcus; Greasley, Peter J.; Skrtic, Stanko

doi:10.1016/j.ekir.2020.07.029

Cited by 24 publications

(17 citation statements)

References 34 publications

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“…First, it is plausible that in these patients with DM of a short duration, they had relatively earlier stages of CKD; early CKD increases the risk of ischemic stroke through its concurrence with other predisposing factors such as hypertension, most of which were already adjusted for in our analyses. Similar findings are reported recently; Cabrera et al [ 36 ], using clinical practice data from United Kingdom, showed that CKD did not alter the risk of IS among a large cohort of patients with DM. Oh and colleagues also demonstrated that there was no association between lower estimated glomerular filtrate rate (eGFR) levels and the risk of HS in a population-based cohort of Korean patients [ 37 ].…”

Section: Discussionsupporting

confidence: 91%

The risk trajectory of different cardiovascular morbidities associated with chronic kidney disease among patients with newly diagnosed diabetes mellitus: a propensity score-matched cohort analysis

Chao

Lee

Wang

et al. 2021

Cardiovasc Diabetol

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Background Chronic kidney disease (CKD) introduces an increased cardiovascular risk among patients with diabetes mellitus (DM). The risk and tempo of cardiovascular diseases may differ depending upon their type. Whether CKD differentially influences the risk of developing each cardiovascular morbidity in patients with newly diagnosed DM remains unexplored. Methods We identified patients with incident DM from the Longitudinal Cohort of Diabetes Patients (LCDP) cohort (n = 429,616), and uncovered those developing CKD after DM and their propensity score-matched counterparts without. After follow-up, we examined the cardiovascular morbidity-free rates of patients with and without CKD after DM, followed by Cox proportional hazard regression analyses. We further evaluated the cumulative risk of developing each outcome consecutively during the study period. Results From LCDP, we identified 55,961 diabetic patients with CKD and matched controls without CKD. After 4.2 years, patients with incident DM and CKD afterward had a significantly higher risk of mortality (hazard ratio [HR] 1.1, 95% confidence interval [CI] 1.06–1.14), heart failure (HF) (HR 1.282, 95% CI 1.19–1.38), acute myocardial infarction (AMI) (HR 1.16, 95% CI 1.04–1.3), and peripheral vascular disease (PVD) (HR 1.277, 95% CI 1.08–1.52) compared to those without CKD. The CKD-associated risk of mortality, HF and AMI became significant soon after DM occurred and remained significant throughout follow-up, while the risk of PVD conferred by CKD did not emerge until 4 years later. The CKD-associated risk of ischemic, hemorrhagic stroke and atrial fibrillation remained insignificant. Conclusions The cardiovascular risk profile among incident DM patients differs depending on disease type. These findings can facilitate the selection of an optimal strategy for early cardiovascular care for newly diagnosed diabetic patients.

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Section: Discussionsupporting

confidence: 91%

The risk trajectory of different cardiovascular morbidities associated with chronic kidney disease among patients with newly diagnosed diabetes mellitus: a propensity score-matched cohort analysis

Chao

Lee

Wang

et al. 2021

Cardiovasc Diabetol

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“…It is widely reported in the literature that patients with chronic renal failure have an increased risk of CCV events and it is interesting to see that even small increases in creatinine help identify patients with an heightened risk of MACE [31][32][33]. In our study, the GFR shows the highest OR (3.6) compared to all the other risk factors, leaving no doubt that for patients with renal insufficiency interventions on the other risk factors are a priority.…”

Section: Therapeutic Possibilities and Cardiovascular Riskmentioning

confidence: 52%

The Burden of Cardio-Cerebrovascular Risk Factors: Differences Between Individual Risk and Population Risk

Capuano¹,

Marchese²,

Capuano

et al. 2021

High Blood Press Cardiovasc Prev

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Introduction Cardio-cerebrovascular (CCV) disease contributes significantly to the global burden of disease, with dramatic consequences in terms of mortality and general health. Mitigate CCV risk factors is the key to reduce individual and population risk of CCV events. Evidence-based medicine and epidemiological investigations of risk factors are essential to optimize actions. Aim To contribute to the knowledge of the burden of risk factors in determining CCV events in the individual patient and in the community. Methods Clinical data and risk factors were collected through a longitudinal survey (1999) as part of a larger epidemiology and cardiovascular prevention project, namely the "VIP (Valle dell'Irno Prevention) Project". We assessed the incidence of major cardiovascular events (MACE) and for each risk factor we calculated: prevalence, absolute risk, odds ratio (OR), additional risk (AR) = risk of exposed to the risk factor − risk of non-exposed, population attributable risk (PAR) = additional risk * prevalence, population attributable risk fraction (PAF) = PAR/total incidence of the disease. Results Comparing the MACE group with the non-MACE group, a statistically significant difference was found for the following: glomerular filtration rate (GFR), glucose and systolic blood pressure (SBP), BMI, diastolic blood pressure (DBP), cholesterol, triglycerides, creatinine and uric acid. GFR, glucose and SBP showed the highest OR. Age, creatinine, glycemia, SBP and uric acid were independent predictor of MACE. When calculating the PAF, the CCV risk factors with the greatest impact on MACE were: SBP (29.6%), triglyceridemia (19.4%) and metabolic syndrome (18.3%). ConclusionThe burden of risk factors on MACE changes substantially according to whether it is calculated in the single patient or in the population. It is crucial for physicians to take these differences into account when applying their own intervention to reduce CCV events.

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“…Major shared risk factors between CKD and CVD include diabetes and hypertension. Diabetes is the leading cause of CKD and dialysis in many countries [30] and considerably increases the risk of various CVD subtypes such as myocardial infarction, stroke, and heart failure [31]. Hypertension is another major cause of CKD and is the leading cause of CVD, especially stroke [32,33].…”

Section: Shared Risk Factors Between Ckd and Cvdmentioning

confidence: 99%

Chronic kidney disease measures for cardiovascular risk prediction

Mok¹,

Ballew²,

Matsushita

2021

Atherosclerosis

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Chronic kidney disease (CKD) affects 15-20% of adults globally and causes various complications, one of the most important being cardiovascular disease (CVD). CKD has been associated with many CVD subtypes, especially severe ones like heart failure, independent of potential confounders such as diabetes and hypertension. There is no consensus in major clinical guidelines as to how to incorporate the two key measures of CKD (glomerular filtration rate and albuminuria) for CVD risk prediction. This is a critical missed opportunity to appropriately refine predicted risk and personalize prevention therapies according to CKD status, particularly since these measures are often already evaluated in clinical care. In this review, we provide an overview of CKD definition and staging, the subtypes of CVD most associated with CKD, major pathophysiological mechanisms, and the current state of CKD as a predictor of CVD in major clinical guidelines. We will introduce the novel concept of a "CKD Add-on", which allows the incorporation of CKD measures in existing risk prediction models, and the implications of taking into account CKD in the management of CVD risk.

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Impact of CKD Progression on Cardiovascular Disease Risk in a Contemporary UK Cohort of Individuals With Diabetes

Cited by 24 publications

References 34 publications

The risk trajectory of different cardiovascular morbidities associated with chronic kidney disease among patients with newly diagnosed diabetes mellitus: a propensity score-matched cohort analysis

The risk trajectory of different cardiovascular morbidities associated with chronic kidney disease among patients with newly diagnosed diabetes mellitus: a propensity score-matched cohort analysis

The Burden of Cardio-Cerebrovascular Risk Factors: Differences Between Individual Risk and Population Risk

Chronic kidney disease measures for cardiovascular risk prediction

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