Cardiovascular Mortality Risk in Chronic Kidney Disease: Comparison of Traditional and Novel Risk Factors

Chronic kidney disease (CKD) is a significant health challenge associated with high cardiovascular mortality risk. Historically, cardiovascular mortality risk has been found to higher in men than women in the general population. However, recent research has highlighted that this risk may be similar or even higher in women than men in the CKD population. To address the inconclusive and inconsistent evidence regarding this relationship between sex and cardiovascular mortality within CKD patients, a systematic review and meta-analysis of articles published between January 2004 and October 2020 using PubMed/Medline, EMBASE, Scopus and Cochrane databases was performed. Forty-eight studies were included that reported cardiovascular mortality among adult men relative to women with 95% confidence intervals (CI) or provided sufficient data to calculate risk estimates (RE). Random effects meta-analysis of reported and calculated estimates revealed that male sex was associated with elevated cardiovascular mortality in CKD patients (RE 1.13, CI 1.03–1.25). Subsequent subgroup analyses indicated higher risk in men in studies based in the USA and in men receiving haemodialysis or with non-dialysis-dependent CKD. Though men showed overall higher cardiovascular mortality risk than women, the increased risk was marginal, and appropriate risk awareness is necessary for both sexes with CKD. Further research is needed to understand the impact of treatment modality and geographical distribution on sex differences in cardiovascular mortality in CKD.

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Circulating trimethylamine-N-oxide and all-cause or cardiovascular mortality risk in patients with chronic kidney disease: a systematic review and meta-analysis

10.37766/inplasy2021.10.0049 ◽

2021 ◽

Author(s):

Zhongwei Zhou ◽

◽

Hao Jin ◽

Huixiang Ju ◽

Mingzhong Sun ◽

...

Keyword(s):

Systematic Review ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Mortality Risk ◽

Cardiovascular Mortality ◽

Meta Analysis ◽

Cardiovascular Mortality Risk

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Emerging Cardiovascular Risk Factors That Account for a Significant Portion of Attributable Mortality Risk in Chronic Kidney Disease

The American Journal of Cardiology ◽

10.1016/j.amjcard.2008.02.060 ◽

2008 ◽

Vol 101 (12) ◽

pp. 1741-1746 ◽

Cited By ~ 27

Author(s):

Mehdi H. Shishehbor ◽

Leonardo P.J. Oliveira ◽

Michael S. Lauer ◽

Dennis L. Sprecher ◽

Kathy Wolski ◽

...

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Cardiovascular Risk ◽

Kidney Disease ◽

Cardiovascular Risk Factors ◽

Mortality Risk ◽

Attributable Mortality

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The Impact of Age on Mortality in Chronic Haemodialysis Popu-Lation with COVID-19

Journal of Clinical Medicine ◽

10.3390/jcm10143022 ◽

2021 ◽

Vol 10 (14) ◽

pp. 3022

Author(s):

Ander Vergara ◽

Mireia Molina-Van den Bosch ◽

Néstor Toapanta ◽

Andrés Villegas ◽

Luis Sánchez-Cámara ◽

...

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Mortality Risk ◽

The Elderly ◽

Elderly Group ◽

High Risk Population ◽

Cox Regression Analysis ◽

Risk Of Death ◽

The Impact

Age and chronic kidney disease have been described as mortality risk factors for coronavirus disease 2019 (COVID-19). Currently, an important percentage of patients in haemodialysis are elderly. Herein, we investigated the impact of age on mortality among haemodialysis patients with COVID-19. Data was obtained from the Spanish COVID-19 chronic kidney disease (CKD) Working Group Registry. From 18 March 2020 to 27 August 2020, 930 patients on haemodialysis affected by COVID-19 were included in the Registry. A total of 254 patients were under 65 years old and 676 were 65 years or older (elderly group). Mortality was 25.1% higher (95% CI: 22.2–28.0%) in the elderly as compared to the non-elderly group. Death from COVID-19 was increased 6.2-fold in haemodialysis patients as compared to the mortality in the general population in a similar time frame. In the multivariate Cox regression analysis, age (hazard ratio (HR) 1.59, 95% CI: 1.31–1.93), dyspnea at presentation (HR 1.51, 95% CI: 1.11–2.04), pneumonia (HR 1.74, 95% CI: 1.10–2.73) and admission to hospital (HR 4.00, 95% CI: 1.83–8.70) were identified as independent mortality risk factors in the elderly haemodialysis population. Treatment with glucocorticoids reduced the risk of death (HR 0.68, 95% CI: 0.48–0.96). In conclusion, mortality is dramatically increased in elderly haemodialysis patients with COVID-19. Our results suggest that this high risk population should be prioritized in terms of protection and vaccination.

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Diet Quality and Protein-Bound Uraemic Toxins: Investigation of Novel Risk Factors and the Role of Microbiome in Chronic Kidney Disease

Journal of Renal Nutrition ◽

10.1053/j.jrn.2021.10.003 ◽

2021 ◽

Author(s):

Catherine McFarlane ◽

Rathika Krishnasamy ◽

Tony Stanton ◽

Emma Savill ◽

Matthew Snelson ◽

...

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Diet Quality ◽

Novel Risk Factors

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Novel risk factors for osteonecrosis of the jaw in multiple myeloma: A RADAR report.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.6623 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 6623-6623

Author(s):

Jaimee S Holbrook ◽

Steven M Trifilio ◽

June M. Mckoy ◽

Seema Singhal ◽

Alfred Rademaker ◽

...

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Multiple Myeloma ◽

Stem Cell ◽

Kidney Disease ◽

Stem Cell Transplant ◽

Osteonecrosis Of The Jaw ◽

Cell Transplant ◽

Rank Analysis ◽

Novel Risk Factors

6623 Background: Osteonecrosis of the jaw (ONJ) was identified in 2001 and is commonly seen in multiple myeloma (MM). The objective of this study is to evaluate novel risk factors in MM cases from a retrospective database. We hypothesized that ONJ may be related to stem cell transplant, chronic kidney disease and active smoking. Methods: We conducted a retrospective case-control study of 231 MM cases (from January 1, 1998 to September 30, 2010) identified from the electronic data warehouse (EDW) at Northwestern University (NU). The EDW is cross-institutional and integrates clinical data across NU. It comprises more than 2.3TB of data on roughly 2 million patients. The search terms used were: bisphosphonates, pamidronate, zoledronic acid, multiple myeloma, plasma cell disorders, osteonecrosis of the jaw, jaw abscess, dental abscess, among other terms described in literature. Data was abstracted onto a standardized form by 2 trained abstractors and validated by a clinician reviewer (BJE). Known and hypothesized new risk factors were abstracted, including duration of myeloma, treatment used, duration of bisphosphonate use, renal function indices, chemotherapy (vincristine, doxorubicin (A), dexamethasone (D) , thalidomide (T), cisplatin (P), cyclophosphamide (C), etoposide (E), novel agents [bevacizumab, sorafenib, angiostatin]) GCSF, smoking, and MM clinical stage. Analyses included T test, Wilcoxon, and log rank analysis. Results: ONJ occurring after MM diagnosis was identified in 33 cases out of a total of 233 cases of MM. ZOL, VAD, DT-PACE, and diabetes were more common in ONJ cases. Log rank analysis identified 2 risk factors for ONJ, the use of DT-PACE (p= 0.003), and complete and partial remission (p=0.007). Stem cell transplant and chronic kidney disease were not associated with ONJ. Conclusions: We identified novel risk factors for ONJ in MM, mainly partial or complete remission and use of DT-PACE. These results should prompt clinicians to heightened awareness and increased surveillance for the symptoms of ONJ for patients treated with DT-PACE.

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Abstract 3479: Emerging Cardiovascular Risk Factors That Account For A Significant Portion Of Attributable Mortality Risk In Chronic Kidney Disease: A Precis Study.

Circulation ◽

10.1161/circ.116.suppl_16.ii_787-a ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Mehdi Shishehbor ◽

Leonardo P. J. Oliveira ◽

Michael Lauer ◽

Dennis Sprecher ◽

Kathy Wolski ◽

...

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Cardiovascular Risk ◽

Kidney Disease ◽

Cardiovascular Risk Factors ◽

Mortality Risk ◽

Attributable Mortality ◽

Preventive Cardiology ◽

Social Security Death Index ◽

Emerging Risk

Background: Chronic kidney disease (CKD) increases cardiovascular risk and mortality. However, traditional cardiovascular risk factors do not adequately account for the substantial increase in mortality observed in CKD. Methods and Results: Prospective cohort study of 4,680 consecutive new patients from a tertiary care preventive cardiology program from 1996 to 2005. Estimated glomerular filtration rate (eGFR) was calculated by the Modification of Diet in Renal Disease (MDRD) method. Baseline levels of traditional (LDL-C, HDL-C, triglycerides, total cholesterol, fasting glucose) and emerging risk factors (apolipoprotein (apo) A1 and apoB, lipoprotein(a), fibrinogen, homocysteine, and CRP) were examined. All-cause mortality was obtained by social security death index. There were 278 deaths for a median follow up of 22 months. CKD (eGFR ≤ 60ml/min) was strongly associated with mortality after adjusting for traditional cardiovascular risk factors (Hazard ratio (HR), 2.31, 95% CI=1.77–3.11, p<0.001) and with addition of propensity score (HR = 2.33, 95% CI=1.75–3.10, p<0.001). Of all the traditional and emerging risk factors monitored, only addition of homocysteine and fibrinogen significantly attenuated the association between CKD and mortality (adjusted HR = 1.73, 95% CI=1.23–2.34, p<0.001), explaining 38% of the attributable mortality risk from CKD. A significant interaction (p = 0.004) between homocysteine and eGFR was observed whereby annual mortality rate in CKD subjects with homocysteine < 10 μmol/L (bottom tertile) was similar to those with normal renal function (1% per year), while homocysteine levels ≥ 12.5 μ mol/L (top tertile) were associated with a 7 fold higher mortality risk. Conclusion: Homocystiene and fibrinogen levels explain 38% of the attributable mortality risk from CKD.

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Physical activity and cardiovascular mortality risk factors: The brisighella heart study

Nutrition Metabolism and Cardiovascular Diseases ◽

10.1016/s0939-4753(03)80097-2 ◽

2003 ◽

Vol 13 (5) ◽

pp. 322

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Mortality Risk ◽

Cardiovascular Mortality ◽

Heart Study ◽

Cardiovascular Mortality Risk

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Prognostic Outcomes in Acute Coronary Syndrome Patients Without Standard Modifiable Risk Factors: A Multi-Ethnic Study Of 8680 Asian Patients

10.21203/rs.3.rs-941766/v1 ◽

2021 ◽

Author(s):

Gwyneth Kong ◽

Nicholas WS Chew ◽

Cheng Han Ng ◽

Yeung Jek Ho ◽

Aaron ST Mai ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Chronic Kidney Disease ◽

Acute Coronary Syndrome ◽

Kidney Disease ◽

Cardiogenic Shock ◽

Cardiovascular Mortality ◽

Multivariable Analysis ◽

Asian Population ◽

Coronary Syndrome

Abstract IMPORTANCEThere are growing concerns that patients suffering from acute coronary syndrome (ACS) without standard modifiable cardiovascular risk factors (SMuRFs), including hypertension, hypercholesterolemia, diabetes and smoking, have increased mortality.OBJECTIVEThis study examined the outcomes of ACS in patients without SMuRFs (termed SMuRF-less) in a multi-ethnic Asian population which remains unknown.DESIGNThis retrospective study was conducted from 1st January 2011 to 31st March 2021.SETTINGThis study was conducted in a tertiary healthcare institution in Singapore.PARTICIPANTSConsecutive patients presenting with ACS disease were recruited in the study.EXPOSUREThe outcomes of SMuRF-less patients were compared with SMuRF patients.MAIN OUTCOMES AND MEASURESThe primary outcome was cardiovascular mortality. Secondary outcomes were all-cause mortality, readmission, cardiogenic shock, stroke and heart failure. Multivariable regression analysis adjusted for covariates including age, sex, ethnicity, chronic kidney disease, ACS type, cardiac arrest, and left main and/or left anterior descending coronaryRESULTSOf the 8680 patients studied, 8.6% were SMuRF-less patients. SMuRF-less patients were significantly younger and had fewer comorbidities including stroke and chronic kidney disease, but higher rates of ventricular arrhythmias and inotropic or invasive ventilation requirement compared to the SMuRF group. Multivariable analysis showed higher rates of cardiovascular mortality (HR 1.48, 95% CI 1.09–1.86, p=0.048), cardiogenic shock (RR: 1.31, 95% CI 1.09–1.52, p=0.015) and stroke (RR: 2.51, 95% CI 1.67–3.34, p=0.030) in SMuRF-less patients compared to SMuRF patients. Both groups had similar readmission (RR: 1.10, 95% CI 0.87–1.39, p=0.413) and heart failure (RR: 0.82, 95% CI 0.56–1.21, p=0.326) rates. Kaplan-Meier curve showed higher 30-day cardiovascular mortality in the SMuRF-less group compared to SMuRF group (HR: 1.84, 95% CI 1.45-2.33, p<0.001), with similar significant trends found in men, STEMI patients, and the three Asian ethnicities. CONCLUSION AND RELEVANCEAlthough the proportion of ACS patients without standard risk factors in our Asian population is lower than those reported in the West, they also have worse short-term mortality compared to those with SMuRF. This calls for a global focus on the management of this unexpectedly high-risk subgroup of patients.

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