A pooled analysis of three community-based cohort studies found that patients with chronic kidney disease had an increased risk of heart failure, coronary heart disease and stroke.
After adjusting for several variables, chronic kidney disease was associated with an increased risk of heart failure that was similar to an increased risk in coronary heart disease. The risk of stroke was lower than the risks for heart failure and coronary heart disease in patients with chronic kidney disease.
Lead researcher Nisha Bansal, MD, of the Kidney Research Institute at the University of Washington, and colleagues published their results online in JAMA Cardiology on Dec. 21.
The researchers evaluated 14,462 adults who enrolled in the Jackson Heart Study between 2000 and 2010, the Cardiovascular Health Study between 1989 and 2003 and the Multi-Ethnic Study of Atherosclerosis between 2000 and 2012. All of the participants did not have heart failure, coronary heart disease or stroke at baseline.
The mean age of participants was 63 years old, while 59 percent were women, 44 percent were African American and 10 percent had chronic kidney disease. The researchers defined chronic kidney disease as an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73 m 2, which was calculated from baseline serum creatinine and crystatin C.
The mean time to a first heart failure event was 8.2 years, the mean time to a first coronary heart disease event was 7.5 years and the mean time to a first stroke event was 7.6 years.
For heart failure, the unadjusted incident rates were 22 per 1,000 person-years for participants with chronic kidney disease and 6.2 per 1,000 person-years for participants without chronic kidney disease.
For coronary heart disease, the unadjusted incidence rates were 24.5 per 1,000 person-years and 8.4 per 1,000 person-years, respectively. For stroke, the unadjusted incidence rates were 13.4 per 1,000 person-years and 4.8 per 1,000 person-years, respectively.
The risk differences for participants with versus without chronic kidney disease were 2.3 per 1,000 person-years for heart failure, 2.3 per 1,000 person-years for coronary heart disease and 0.8 per 1,000 person-years for stroke after adjusting for demographics, cohort, hypertension, diabetes, hyperlipidemia and tobacco use.
The researchers said the risk difference for heart failure and coronary heart disease was highest for Hispanic participants, although there were fewer Hispanics than non-Hispanics.
A sensitivity analysis found the adjusted risk difference for heart failure and coronary heart disease was highest for participants with a low eGFR and a high urine albumin to creatinine ratio. Another sensitivity analysis found the adjusted risk differences for incident heart failure, coronary heart disease and stroke were highest for participants with an eGFR of less than 45 mL/min/1.73 m 2 compared with those with an eGFR of greater than 60 mL/min/1.73 m 2.
“Our findings are consistent with prior reports that have shown that [chronic kidney disease] is associated with excess risk of cardiovascular disease,” the researchers wrote. “Our study augments this body of work by comparing rates of specific cardiovascular disease subtypes in patients with vs without [chronic kidney disease]. We evaluated risk in absolute terms, which may translate most directly to the public health benefit that could be derived from effectively preventing or treating a specific subtype of cardiovascular disease.”
The researchers acknowledged a few limitations of the analysis, including that the three studies were conducted at different times, so they could not account for changes in cardiovascular medication usage or other trends. They also mentioned that most of the participants had moderate chronic kidney disease, so the results might not be generalizable to adults with more advanced stages of the disease.
“Our study highlights the need for future investigations to understand and prevent cardiovascular disease among patients with [chronic kidney disease] to improve long-term outcomes in this vulnerable population,” the researchers wrote.