Risk of End-Stage Renal Disease and Death after Cardiovascular Events in Chronic Kidney Disease

Abstract

Background—Patients with chronic kidney disease (CKD) stages 3-5 (glomerular filtration rate <60ml/min/1.73m²) are at increased risk of cardiovascular (CV) disease when compared to patients with less severe CKD. How CV events modify the subsequent risk of progression to end-stage-renal disease (ESRD) or all-cause mortality (ACM) prior to ESRD is not well known.

Methods and Results—This retrospective cohort study involved 2964 CKD subjects referred between January 2001 and December 2008 to the nephrology clinic at Sunnybrook Health Sciences Centre, Toronto, Ontario. Interim CV events (heart failure, myocardial infarction, and stroke), ESRD and ACM were ascertained from administrative data. Over a median follow-up time of 2.76 years (IQR: 1.45-4.62), 447 (15%) subjects had a CV event. In the same time period, 318 (11%) developed ESRD, and 446 (15%) suffered ACM prior to ESRD (156 [5%] from a CV and 290 [10%] from a non-CV-related cause). When analyzed as a time-dependent variable, an interim CV event was associated with a higher risk of subsequent ESRD (HR=5.33, 95% CI: 3.74-7.58) and ACM prior to ESRD (HR=4.15, 95% CI: 3.30-5.23). The HR for CV-related death vs non-CV related death prior to ESRD was 12.38 (95% CI: 8.30-18.45) vs. 2.13 (95% CI: 1.57-2.87).

Conclusions—CV events are common in patients with CKD stages 3-5 and are associated with a substantial increase in the risk of ESRD and ACM prior to ESRD. Intensive primary and secondary prevention strategies may help attenuate this risk.