Increased risk of cardiovascular events and mortality among non-diabetic chronic kidney disease patients with hypertensive nephropathy: the Gonryo study

Hyperphosphatemia in renal pathology is a key factor for developing mineral and bone disorders. It can develop even in the early stages of renal function decline and predict the formation of vascular calcification and an increased risk for developing cardiovascular complications in patients with chronic kidney disease, especially in those, who receive program hemodialysis. The use of calcium-free phosphate-binding agents that are not associated with the risk for developing hypercalcemia can slow the development of vascular calcification, reduce the incidence of adverse cardiovascular events and mortality in patients with chronic kidney disease.

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MO465PROGNOSTIC IMPLICATION OF URINARY POTASSIUM EXCRETION IN PATIENTS WITH CHRONIC KIDNEY DISEASE

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab090.0027 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Daisuke Mori ◽

Shinjiro Tamai ◽

Maho Tokuchi ◽

Natsumi Inoue ◽

Hideaki Kawai ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Serum Potassium ◽

Cardiovascular Events ◽

Renal Outcome ◽

Potassium Excretion ◽

Ckd Progression ◽

Increased Risk ◽

Urinary Potassium ◽

All Cause Mortality

Abstract Background and Aims Plasma potassium levels are impacted by decreased kidney function and are known to be associated with increased mortality, adverse cardiovascular events and adverse kidney events. However, the prognostic implication of urinary potassium is unclear. Method We conducted an observational study of 1102 patients with chronic kidney disease (CKD) who were hospitalized between 2010 and 2018. The expected primary outcomes were all-cause mortality, adverse cardiovascular events and CKD progression. CKD progression was defined as a 30% increase in serum creatinine, the initiation of maintenance dialysis or the need for kidney transplantation. The Cox proportional hazards model was used to analyse the association between urinary potassium excretion and adverse clinical outcomes after adjustment for potential confounders. Results At baseline, 66% of the patients were men, with a median age of 72 years (interquartile range or IQR, 64–79 years); 61% of the patients were diabetic, and 54% of them were hypertensive. The median values for estimated glomerular filtration rate (eGFR) was 12 mL/min/1.73m2 (IQR, 8–18), serum potassium 4.5 mmol/L (IQR, 4.1–5.1) and urinary potassium/creatinine ratio (UK/Cr) 27 mmol/gCr (IQR, 20–38). Over a median follow-up period of 2.6 years (IQR 0.2–4.5), the number of all-cause deaths was 87. There were 171 cases of cardiovascular events and 860 cases of CKD progression. After adjusting for the eGFR, serum potassium level, proteinuria, renin–angiotensin system inhibitors, diuretics and other potential confounders, UK/Cr was found to be neither significantly associated with all-cause mortality nor with adverse cardiovascular events. However, a low UK/Cr was associated with an increased risk of CKD progression (adjusted hazard ratio [95% confidence interval] for the first, second and third quartiles, compared with the fourth quartile, were as follows: 2.09 [1.43-3.06], 1.33 [0.96-1.86] and 1.05 [0.75-1.46]) Conclusion A low UK/Cr might be an independent risk factor for poor renal outcome.

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Asymptomatic Ventricular Arrhythmia and Clinical Outcomes in Chronic Kidney Disease: A Pilot Study

Cardiorenal Medicine ◽

10.1159/000449260 ◽

2016 ◽

Vol 7 (1) ◽

pp. 66-73 ◽

Cited By ~ 6

Author(s):

Fabiana Oliveira Bastos Bonato ◽

Renato Watanabe ◽

Marcelo Montebello Lemos ◽

José Luiz Cassiolato ◽

Myles Wolf ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Pilot Study ◽

Kidney Disease ◽

Ventricular Arrhythmia ◽

Clinical Outcomes ◽

Cardiovascular Events ◽

Composite Outcome ◽

Ventricular Extrasystoles ◽

Increased Risk

Background/Aims: Ventricular arrhythmia is associated with increased risk of cardiovascular events and death in the general population. Sudden death is a leading cause of death in end-stage renal disease. We aimed at evaluating the effects of ventricular arrhythmia on clinical outcomes in patients with earlier stages of chronic kidney disease (CKD). Methods: In a prospective study of 109 nondialyzed CKD patients (estimated glomerular filtration rate 34.8 ± 16.1 ml/min/1.73 m2, 57 ± 11.4 years, 61% male, 24% diabetics), we tested the hypothesis that the presence of subclinical complex ventricular arrhythmia, assessed by 24-hour electrocardiogram, is associated with increased risks of cardiovascular events, hospitalization, and death and with their composite outcome during 24 months of follow-up. Complex ventricular arrhythmia was defined as the presence of multifocal ventricular extrasystoles, paired ventricular extrasystoles, nonsustained ventricular tachycardia, or R wave over T wave. Results: We identified complex ventricular arrhythmia in 14% of participants at baseline. During follow-up, 11 cardiovascular events, 15 hospitalizations, and 4 deaths occurred. The presence of complex ventricular arrhythmia was associated with cardiovascular events (p < 0.001), hospitalization (p = 0.018), mortality (p < 0.001), and the composite outcome (p < 0.001). In multivariate Cox regression analysis, adjusting for demographic characteristics, complex ventricular arrhythmia was associated with increased risk of the composite outcome (HR 4.40; 95% CI 1.60-12.12; p = 0.004). Conclusion: In this pilot study, the presence of asymptomatic complex ventricular arrhythmia was associated with poor clinical outcomes in nondialyzed CKD patients.

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Association between serum phosphorus levels and adverse outcomes in chronic kidney disease: an observational cohort study

10.21203/rs.3.rs-329816/v1 ◽

2021 ◽

Author(s):

Akira Oda ◽

Kenichi Tanaka ◽

Hirotaka Saito ◽

Tsuyoshi Iwasaki ◽

Shuhei Watanabe ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Cohort Study ◽

Kidney Disease ◽

Cardiovascular Events ◽

Cox Regression ◽

Hazard Ratio ◽

Adverse Outcomes ◽

Serum Phosphorus ◽

Increased Risk ◽

Phosphorus Levels

Abstract Background Although an association between serum phosphorus levels and poor prognosis has been noted in dialysis patients, these associations have been insufficiently reported in non-dialysis dependent chronic kidney disease (NDD-CKD) patients. This study attempted to determine the association between serum phosphorus levels and adverse outcomes in Japanese NDD-CKD patients. Methods We investigated the relationships between serum phosphorus levels and adverse outcomes such as kidney events, cardiovascular events, and all-cause death in Japanese NDD-CKD patients, using the longitudinal data of the Fukushima CKD Cohort Study. The study evaluated 822 patients with NDD-CKD enrolled between June 2012 and July 2014. A kidney event was defined as a combination of doubling of the baseline serum creatinine or end-stage renal disease. Cox regression was performed to analyze the relationships of the quartile of the serum phosphorus with kidney events, cardiovascular events, and all-cause death. Results Over a median follow-up period of 2.8 years, 46 patients died, there were 50 cardiovascular events, and 102 kidney events occurred. Increased risk of kidney events was observed in patients with higher serum phosphorus, with the lowest risk shown to be a second quartile of serum phosphorus level of 2.9–3.2 mg/dL. Multivariable Cox regression analysis showed an increased risk of kidney events for the highest quartile of the serum phosphorus levels (≥ 3.7 mg/dL) versus the second quartile (2.9–3.2 mg/dL, hazard ratio, 3.62; 95% confidence interval, 1.65–7.94; P = 0.001). A 1 mg/dL increase of the serum phosphorus was associated with an adjusted hazard ratio of 1.66 (95% CI; 1.24–2.20) for the kidney events. There were no significant associations between the serum phosphorus levels at baseline and the risk of cardiovascular events and all-cause death. Conclusions Serum phosphorus levels were associated with an increased risk of CKD progression in Japanese NDD-CKD patients.

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Effect of Erythropoietin Stimulating Agents on Cardiovascular Events in Chronic Kidney Disease Patients on Hemodialysis

Annals of King Edward Medical University ◽

10.21649/akemu.v23i2.1577 ◽

2017 ◽

Vol 23 (2) ◽

Author(s):

Ali Asad Khan ◽

Somia Iqtadar ◽

Yasir Shafi ◽

Sajid Abaidullah ◽

Aasma Refai

Keyword(s):

Social Sciences ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Cardiovascular Events ◽

Increased Risk ◽

Ckd Stage ◽

Direct Association ◽

New Evidence ◽

Erythropoietin Stimulating Agents ◽

Made In

Objectives: Patients with chronic kidney disease (CKD) develop anemia which is treated with erythropoietin-stimulating agents (ESAs). However, ESAs do not reduce the risk of cardiovascular mortality. Furthermore, this is unclear whether ESAs therapy has any association with adverse cardiovascular events.Methods: After an informed consent 275 male and female patients, between ages 35 to 75 years, with CKD stage V on ESAs undergoing twice weekly hemodialysis were enrolled. The dose of ESAs was calculated according to weight as 50mg/kg with target hemoglobin being 11 – 12 g/dl. Dose adjustments were made in the patients who failed to achieve target hemoglobin. The patients were followed for a year with the primary end point being new evidence of acute myocardial infarction (MI) diagnosed through ECG or echocardiography. Safety outcomes included stroke or death.Results: The data was entered and analyzed in Statistical Package for Social Sciences (SPSS) version 18Out of 275 patients, 164 (59.6%) patients were males and 111 (40.4%) were females. Mean age of the patients was 51.52 with standard deviation of ± 5.73. According to the results, 52 (18.9%) patients reported with MI and 223 (81.1%) patients had no evidence of MI. Out of 52 patients who had MI, 37 (71.1%) were males and 15 (28.8%) patients were female.Conclusion: ESAs are associated with an increased risk of MI in CKD patients on hemodialysis. Whether there is a direct association or there are other factors involved remains to be seen.

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P1709 Left atrial strain: a novel prognostic marker in patients with chronic kidney disease

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.1072 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

G Gan ◽

K Kadappu ◽

A Bhat ◽

F Fernandez ◽

K Gu ◽

...

Keyword(s):

Diabetes Mellitus ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Left Atrial ◽

Cardiovascular Events ◽

Independent Predictor ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

End Point ◽

Increased Risk

Abstract Funding Acknowledgements Nil Background and objectives Patients with chronic kidney disease (CKD) are at increased risk of adverse cardiovascular events that are underestimated by traditional risk stratification algorithms. We sought to determine clinical and echocardiographic predictors of adverse outcomes in CKD patients. Methods Stage 3 and 4 CKD patients without previous cardiac disease underwent a comprehensive transthoracic and stress echocardiogram, with left ventricular (LV) and left atrial (LA) strain analysis. Participants were followed for the primary end point of a composite of all-cause death and major adverse cardiovascular events (MACE). The secondary end point was a composite of cardiovascular death and MACE. Results 243 patients (male 63%; mean age 59.2 ± 14.4 years) were followed for a median of 3.9 ± 2.7 years. 69 patients met the primary endpoint and 58 the secondary end point. Age (p < 0.01), history of diabetes mellitus (p < 0.01), indexed LV mass(LVMI) (p < 0.01), LV global longitudinal strain(GLS) (p < 0.01), indexed LA volume(LAVI) (p < 0.01), E/e’ ratio (p < 0.01) and LA strain (LAs) (p < 0.01) were independent predictors of death and MACE. On Cox proportional hazards regression analysis, LAs (p < 0.01) was the only independent predictor for the primary end point in a model accounting for age, diabetes mellitus, LVMI, LVGLS, E/e’ and LAVI. LAs remained an independent predictor for the secondary end point. Conclusions LAs is an independent predictor of death and MACE in CKD patients, in whom the predominant cardiac abnormality is diastolic impairment. LAs is a prognostic biomarker, reflecting alterations in diastolic function in CKD. Abstract P1709 Figure. Kaplan Meier curve of LAs

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Elevated serum γ-glutamyltransferase activity is associated with increased risk of mortality, incident type 2 diabetes, cardiovascular events, chronic kidney disease and cancer – a narrative review

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm.2010.031 ◽

2010 ◽

Vol 48 (2) ◽

Cited By ~ 63

Author(s):

Giovanni Targher

Keyword(s):

Type 2 Diabetes ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Cardiovascular Events ◽

Elevated Serum ◽

Incident Type ◽

Risk Of Mortality ◽

Increased Risk ◽

Incident Type 2 Diabetes

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Unawareness for chronic kidney disease is high in all stages, age groups and comorbidities and higher in women than in men

10.1101/2021.05.21.21257582 ◽

2021 ◽

Author(s):

Susanne Stolpe ◽

Bernd Kowall ◽

Christian Scholz ◽

Andreas Stang ◽

Cornelia Blume

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Cardiovascular Events ◽

Age Groups ◽

Physician Communication ◽

Disease Awareness ◽

Cardiovascular Comorbidities ◽

Increased Risk ◽

Ckd Stage ◽

Prevalence Ratios

Background Chronic kidney disease (CKD) is associated with an increased risk for cardiovascular events, hospitalizations or mortality. In populations aged >40 years, CKD is as prevalent as diabetes or coronary heart disease. Awareness for CKD though is generally low in public, patients and physicians, which hinders early diagnosis and treatment to decelerate disease progress. Method We analyzed baseline data collected in 2010 from 3,334 participants with CKD stages 1-5 from German CKD cohorts and registries. CKD unawareness and 95%-confidence intervals (CI) was estimated according to patients answer to the question whether they had ever been told to suffer from a CKD. Prevalence ratios (PR) with 95%-CI were estimated in categories of age, sex, CKD stages, BMI, hypertension, diabetes and other relevant comorbidities. Results CKD unawareness was high, reaching 82% (95% CI: 80%-84%) for CKD stages 1 or 2, 71% (68%-73%) in CKD 3a, 49% (45%-54%) in CKD 3b and still 30% (24%-36%) in CKD4, in each stage increasing with age. CKD unawareness was similarly high in patients with hypertension, diabetes or cardiovascular comorbidities. Women were more often unaware than men (PR=1.07 (1.02;1.12)), this sex difference increased with increasing CKD stage. Macroalbuminuria (PR=0.90 (0.82; 1.00)), anemia (PR=0.78 (0.73; 0.83)) and BMI ≥40 (PR=0.88 (0.77; 1.00)) were associated with higher CKD awareness. Conclusion Even in older patients or in patients with comorbidities, CKD unawareness was high. Sex differences were largest in later stages. Guideline oriented treatment of patients with hypertension or diabetes could increase awareness. Patient-physician communication about CKD might be amendable.

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EVALUATION OF 2-D ECHO FINDINGS IN CHRONIC KIDNEY DISEASE :A CASE STUDY OF 50 END STAGE RENAL DISEASE PATIENTS

10.36106/paripex/9600483 ◽

2020 ◽

pp. 1-2

Author(s):

Ruby Patel ◽

Deepak Baldania ◽

Babulal Bamboria

Keyword(s):

Heart Failure ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Cardiovascular Mortality ◽

Cardiovascular Events ◽

Left Ventricular ◽

Major Public Health Problem ◽

Cardiac Abnormalities ◽

Increased Risk ◽

Esrd Patients

Chronic kidney disease (CKD) is a major public health problem worldwide with increase in incidence and prevalence. Diabetes and hypertension are the leading cause of CKD worldwide, whereas hypertension is a cause as well as effect of CKD. CKD is a risk factor for cardiovascular events and complications which increase as CKD progress to ESRD [3]. Cardiovascular mortality is 10-20 times more common in ESRD patients on renal replacement therapy as compared to general population. One of the major structural cardiac abnormalities in CKD patients is left ventricular hypertrophy (LVH) and is associated with increased risk for cardiac ischemia, congestive heart failure, as well as a very strong independent predictor for cardiovascular mortality [4]. Majority patients with CKD die due to cardiovascular events before reaching ESRD due to risk factors [5]. Anemia and hypertension are most consistent with heart failure that causes 2/3rd death of all dialysis patients. ESRD patients do have myriads of structural and functional cardiac abnormalities which include LVH, depressed LV function, regional wall motion abnormality, pericardial effusion and valvular calcification.

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Low-dose aspirin was associated with an increased risk of cardiovascular events in patients with chronic kidney disease patients and low bodyweight: results from KNOW-CKD study

Scientific Reports ◽

10.1038/s41598-021-86192-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yun Jung Oh ◽

Ae Jin Kim ◽

Han Ro ◽

Jae Hyun Chang ◽

Hyun Hee Lee ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Cardiovascular Events ◽

Low Dose ◽

Bleeding Event ◽

Dose Aspirin ◽

Increased Risk ◽

Low Dose Aspirin ◽

First Occurrence ◽

Secondary Outcomes

AbstractThe benefits and risks of aspirin therapy for patients with chronic kidney disease (CKD) who have a high burden of cardiovascular events (CVE) are controversial. To examine the effects of low-dose aspirin on major clinical outcomes in patients with CKD. As a prospective observational cohort study, using propensity score matching, 531 aspirin recipients and non-recipients were paired for analysis from 2070 patients and fulfilled the inclusion criteria among 2238 patients with CKD. The primary outcome was the first occurrence of major CVE. The secondary outcomes were kidney events defined as a > 50% reduction of estimated glomerular filtration rate from baseline, doubling of serum creatinine, or onset of kidney failure with replacement therapy, the all-cause mortality, and bleeding event. The incidence of CVE was significantly greater in low-dose aspirin users than in non-users (HR 1.798; P = 0.011). A significant association between aspirin use and an increased risk of CVE was observed only in the lowest quartile of body weight (HR 4.014; P = 0.019) (Q1 < 60.0 kg). Secondary outcomes were not significantly different between aspirin users and non-users. It needs to be individualized of prescribing low-dose aspirin for the prevention of cardiovascular events in patients with chronic kidney disease, particularly patients with low bodyweight (< 60 kg).

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