Abstract
Background and Aims
Patients with chronic kidney disease (CKD) stage 4-5 have an increased risk of cardiovascular morbidity and mortality.
Method
We recruited 174 consecutive patients with CKD stage 4-5 between 2013 and 2017 into a prospective follow-up study assessing arterial disease, quality of life, mortality and their predictors. Together with baseline medical data, standard maximal bicycle ergometry stress testing, abdominal aortic calcification score (AAC) and echocardiography was collected. Patients were followed up for mean 42 months.
Results
Mean age at recruitment was 61 years, 54 (31%) were women and estimated glomerular filtration rate (eGFR) was 12.9 ml/min. Altogether, 36 (21%) patients died during follow-up with a mean time to death of 835 days. At baseline, all but one patient were hypertensive, 75 patients had diabetes and 21 patients had coronary artery disease. Mean AAC was 6.27±5.68 and work load of the last 4 minutes of maximal stress (WMAX) was 83.7±36.5W, respectively. In the multivariate proportional hazard models pro-BNP [1.98 (95% CI 1.36 – 2.90), p=0.0004], WMAX [HR 0.45 (95% CI 0.27 – 0.77), p=0.0033], AAC [HR 2.51 (95% CI 1.37 – 4.61), p=0.0030], E/e’ –ratio [HR 1.66 (95% CI 1.08 – 2.56), p=0.0221] and albumin [HR 0.59 (95% CI 0.39 – 0.90), p=0.0134] were significant predictors for mortality when adjusted with age, sex, diabetes and previous coronary artery disease. Patients who perished, especially those who died in less than 2 years, within follow-up had significantly higher AAC and lower WMAX compared to those surviving to the end of the study (Figure 1).
Conclusion
Maximal stress ergometry test work load and AAC are associated with patient survival in severe CKD.
CT-based abdominal aortic calcification score as a surrogate marker for predicting the presence of asymptomatic coronary artery disease
