Abstract 12633: Coronary Artery Disease is a Predictor of Progression to Dialysis in Patients With Chronic Kidney Disease, Type 2 Diabetes, and Anemia: An Analysis of the TREAT Trial
Introduction: Cardiovascular disease (CVD) is the leading cause of death in patients with type 2 diabetes mellitus (T2DM) and in those with chronic kidney disease (CKD). Although there is clear evidence that CKD is a predictor of cardiovascular events, death, and accelerated coronary artery disease (CAD) progression, it remains unknown whether CAD is a predictor of progression of CKD to end stage renal disease (ESRD).
Hypothesis: We sought to assess whether CAD adds prognostic information to established predictors of progression to dialysis in patients with CKD, T2DM, and anemia.
Methods: Using the previously described TREAT population, we evaluated differences in baseline characteristics and outcomes in patients with and without a history of CAD (based on a self-reported history of CAD, MI, CABG, or PCI). Cox proportional hazards models were used to assess the association between CAD and time to ESRD and time to ESRD or death.
Results: Of the 4038 patients, 1791 had a history of CAD. Patients with CAD were significantly older (mean age 70 vs 65 years, p<0.001), more likely to be of white race (73% vs 57%, p<0.001), and had more history of other cardiovascular diseases. CAD patients were less likely to have marked proteinuria, defined as a protein/creatinine ratio>1 (29% vs 39%, p<0.001), but had no significant difference in eGFR compared to the non-CAD patients (35.2 vs 35.1 ml/min/1.73m2, p=0.93). After adjusting for age, race, eGFR, proteinuria, albumin, and 12 other renal risk factors, patients with CAD were significantly more likely to progress to ESRD (adj HR 1.20 [1.01-1.42], p=0.04) and to have the composite of ESRD or death (adj HR 1.14 [1.01-1.30], p=0.03). See Figure.
Conclusions: In patients with CKD, T2DM, and anemia, we found that a history of CAD is an independent predictor of progression to dialysis. Thus, in patients with diabetic nephropathy, a history of CAD contributes important prognostic information to traditional risk factors for worsening renal disease.
Author Disclosures: M.A. Sabe: None. B. Claggett: None. E.A. Burdmann: Research Grant; Significant; Amgen, Roche. Consultant/Advisory Board; Modest; Amgen, Sigma Pharma. A.S. Desai: Other; Modest; Amgen. P. Ivanovich: Consultant/Advisory Board; Modest; Baxter, Reata. Consultant/Advisory Board; Significant; Amgen, Physician Software Systems, LLC. R. Kewalramani: Employment; Significant; Amgen. Ownership Interest; Significant; Amgen. E.F. Lewis: None. J.J. McMurray: None. K.A. Olson: Employment; Significant; Amgen. Ownership Interest; Modest; Amgen. P. Parfrey: Honoraria; Modest; Amgen. Consultant/Advisory Board; Modest; Amgen. S.D. Solomon: Research Grant; Significant; Amgen. Consultant/Advisory Board; Modest; Amgen. M.A. Pfeffer: Research Grant; Significant; Amgen, Celladon, Novartis, Sanofi Aventis. Ownership Interest; Modest; co-inventor on a patent for the use of inhibitors of the renin-angiotensin system in selected survivors of MI; his share is transferred to charity. Consultant/Advisory Board; Modest; Aastrom, Abbott Vascular, Amgen, Bristol-Myers Squibb, Cerenis, Concert, Fibrogen, Genzyme, GlaxoSmithKline, Hamilton Health Sciences, Medtronic, Merck, Novo Nordisk, Roche, Salix, Sanderling, Serono, Servier, Teva, University of Oxford.
- © 2014 by American Heart Association, Inc.