Mortality and Recovery Associated with Kidney Failure due to Acute Kidney Injury

Background and objectivesAKI requiring dialysis is a contributor to the growing burden of kidney failure, yet little is known about the frequency and patterns of recovery of AKI and its effect on outcomes in patients on incident dialysis.Design, setting, participants, & measurementsUsing the US Renal Data System, we evaluated a cohort of 1,045,540 patients on incident dialysis from January 1, 2005 to December 31, 2014, retrospectively. We examined the association of kidney failure due to AKI with the outcome of all-cause mortality and the associations of sex and race with kidney recovery.ResultsMean age was 63±15 years, and 32,598 (3%) patients on incident dialysis had kidney failure due to AKI. Compared with kidney failure due to diabetes mellitus, kidney failure attributed to AKI was associated with a higher mortality in the first 0–3 months following dialysis initiation (adjusted hazard ratio, 1.28; 95% confidence interval, 1.24 to 1.32) and 3–6 months (adjusted hazard ratio, 1.16; 95% confidence interval, 1.11 to 1.20). Of the patients with kidney failure due to AKI, 11,498 (35%) eventually recovered their kidney function, 95% of those within 12 months. Women had a lower likelihood of kidney recovery than men (adjusted hazard ratio, 0.86; 95% confidence interval, 0.83 to 0.90). Compared with whites, blacks (adjusted hazard ratio, 0.68; 95% confidence interval, 0.64 to 0.72), Asians (adjusted hazard ratio, 0.82; 95% confidence interval, 0.69 to 0.96), Hispanics (adjusted hazard ratio, 0.82; 95% confidence interval, 0.76 to 0.89), and Native Americans (adjusted hazard ratio, 0.72; 95% confidence interval, 0.54 to 0.95) had lower likelihoods of kidney recovery.ConclusionsKidney failure due to AKI confers a higher risk of mortality in the first 6 months compared with kidney failure due to diabetes or other causes. Recovery within 12 months is common, although less so among women than men and among black, Asian, Hispanic, and Native American patients than white patients.

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Glycemic Measures and Risk of Mortality in Older Chinese: The Guangzhou Biobank Cohort Study

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgz173 ◽

2019 ◽

Vol 105 (3) ◽

pp. e181-e190 ◽

Cited By ~ 1

Author(s):

Chao Qiang Jiang ◽

Lin Xu ◽

Tai Hing Lam ◽

Ya Li Jin ◽

Wei Sen Zhang ◽

...

Keyword(s):

Cohort Study ◽

Confidence Interval ◽

Mortality Risk ◽

Fasting Glucose ◽

Tolerance Test ◽

Hazard Ratio ◽

Oral Glucose ◽

Risk Of Mortality ◽

All Cause Mortality ◽

Diagnosed Diabetes

Abstract Context China has the largest number of people with type 2 diabetes mellitus (T2DM) in the world. Data from previous studies have suggested that up to one-fifth of individuals with diabetes would be missed without an oral glucose tolerance test (OGTT). To date, there is little information on the mortality risk of these individuals. Objective We estimated the association of different indicators of hyperglycemia with mortality in the general Chinese population. Design Prospective cohort study. Setting China. Participants A total of 17 939 participants aged 50+ years. Exposures Previously diagnosed diabetes and newly detected diabetes defined by fasting glucose (≥7.0 mmol/L), 2-hour postload glucose (≥11.1 mmol/L), or hemoglobin A1c (HbA1c, ≥6.5%). Main Outcomes Measures Deaths from all-cause, cardiovascular disease, and cancer were identified by record linkage with death registration. Results During 7.8 (SD, 1.5) years’ follow-up, 1439 deaths were recorded. Of 3706 participants with T2DM, 2126 (57%) had known T2DM, 118 (3%) were identified by isolated elevated fasting glucose, 1022 (28%) had isolated elevated postload glucose, and 440 (12%) had both elevated fasting and postload glucose. Compared with normoglycemia, the hazard ratio (95% confidence interval) of all-cause mortality was 1.71 (1.46-2.00), 0.96 (0.47-1.93), 1.43 (1.15-1.78), and 1.82 (1.35-2.45) for the 4 groups, respectively. T2DM defined by elevated HbA1c was not significantly associated with all-cause mortality (hazard ratio, 1.17; 95% confidence interval, 0.81-1.69). Conclusion Individuals with isolated higher 2-h postload glucose had a higher risk of mortality by 43% than those with normoglycemia. Underuse of OGTT leads to substantial underdetection of individuals with a higher mortality risk and lost opportunities for early intervention.

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Urate lowering therapy is associated with a lower risk of heart failure hospitalisation or mortality in hyperuricaemic patients with heart failure: a comparative effectiveness study

European Heart Journal ◽

10.1093/eurheartj/ehab724.0904 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

S.J Kiddle ◽

A Abdul-Sultan ◽

K Andersson Sundell ◽

S Nolan ◽

S Perl ◽

...

Keyword(s):

Heart Failure ◽

Uric Acid ◽

Propensity Score ◽

Confidence Interval ◽

Lower Risk ◽

Hazard Ratio ◽

Adjusted Hazard Ratio ◽

Adverse Health Outcomes ◽

Lowering Therapy ◽

All Cause Mortality

Abstract Background There is a strong association between hyperuricemia (elevated serum uric acid) and the risk of heart failure. However, it remains unclear whether prescribing urate lowering therapies have any bearing on long term clinical outcomes. Purpose In this study, we assessed the impact of urate lowering therapy treatment on the risk of adverse health outcomes (hospitalisation for heart failure and all-cause mortality) in patients with hyperuricemia and heart failure. Methods We utilised data from Clinical Practice Research Datalink (CPRD) GOLD, a UK-based primary care database linked to secondary care (Hospital Episode Statistics) and mortality data (Office of National Statistics). The study population included patients with a first record of hyperuricemia (serum uric acid >7 mg/dl for men and >6 mg/dl for women or a gout diagnosis) between 1990 and 2019 with a history of heart failure. Incident urate lowering therapy users were identified post hyperuricemia diagnosis. To account for potential confounding variables and potential treatment paradigm changes over the study period, a propensity score matched cohort was constructed for urate lowering therapy initiators and non-initiators within 6 month accrual blocks. Adverse health outcomes were compared between matched treatment groups using Cox regression analysis adjusted for the same variables used in the propensity score. Due to extensive treatment switching and discontinuation, on-treatment analysis was the main analysis. Results A total of 2,174 propensity score matched pairs were identified. We found that urate lowering therapy was associated with a 43% lower risk of all-cause mortality or hospitalization for heart failure (Figure 1, adjusted hazard ratio 0.57, 95% confidence interval 0.51–0.65), and a 19% lower risk of cardiovascular mortality or hospitalization for heart failure (Figure 2, adjusted hazard ratio 0.81, 95% confidence interval 0.71–0.92) within five years compared to those not on therapy (on-treatment analysis). In an intention-to-treat sensitivity analysis, urate lowering therapy was associated with a 17% lower risk of all-cause mortality or hospitalization for heart failure (adjusted hazard ratio 0.83, 95% confidence interval 0.76–0.91), and a 11% lower risk of cardiovascular mortality or hospitalization for heart failure (adjusted hazard ratio 0.89, 95% confidence interval 0.81–0.98) within five years compared to those not on urate lowering therapy. Adjusted and non-adjusted hazard ratios were consistent for all outcomes. Conclusion We found that urate lowering therapy was associated with a lower risk of adverse outcomes in hyperuricemia or gout patients with a history of heart failure. These results are consistent with the hypothesis that uric acid lowering may lead to improved outcome in patients with heart failure and hyperuricemia, emphasizing the need to investigate the potential benefits of intense uric acid lowering in prospective randomized controlled trials. FUNDunding Acknowledgement Type of funding sources: Private company. Main funding source(s): AstraZeneca Figure 1 (HF = heart failure) Figure 2 (CV = cardiovascular)

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Abstract 10982: Persistence of “Gender Gap” in St-segment Elevation Myocardial Infarction Networks

Circulation ◽

10.1161/circ.132.suppl_3.10982 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Diego Fernández-Rodríguez ◽

Ander Regueiro ◽

Xavier Freixa ◽

Marc Trilla ◽

Mónica Masotti

Keyword(s):

Myocardial Infarction ◽

Confidence Interval ◽

Gender Gap ◽

Hazard Ratio ◽

Adjusted Hazard Ratio ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

All Cause Mortality ◽

One Year

Introduction: Prognosis and management of women with ST-segment elevation myocardial infarction remains controversial. Hypothesis: The gender (female sex) influences the prognosis and the care of patients in a regional myocardial infarction network. Methods: Outcomes of patients activated by the Catalan network between January 2010 and December 2011, were analyzed according to gender. Time intervals, revascularization proportion, type of revascularization, in-hospital all-cause mortality and complications, 30-day all-cause mortality and one-year all-cause mortality were evaluated. Results: From a total of 5831 patients activated by the myocardial infarction network, 4380 patients had a diagnosis of ST-segment elevation myocardial infarction, and 961 (21.9%) of them were women. Women were older (69.8±13.4 vs. 60.6±12.8, p<0.001), had a higher prevalence of diabetes (27.1% vs. 18.1%, pI (24.9% vs. 17.3%, p<0.001), and no reperfusion (8.8% vs. 5.2%, p<0.001) as compared with men. In addition, women had greater time delays in medical care (first medical contact-to-balloon: 132-minutes vs. 122-minutes, p<0.001; symptoms onset-to-balloon: 236-minutes vs. 210-minutes, p<0.001). Women presented higher percentages of overall in-hospital complications (20.6% vs. 17.4%, p=0.031), in-hospital mortality (4.8% vs. 2.6%, p=0.001), 30-day mortality (9.1% vs. 4.5%, p<0.001) and one-year mortality (14.0% vs. 8.3%, p<0.001) compared with men. Nevertheless, after multivariate adjustment, no differences in 30-day and one-year mortality were observed (30-day adjusted hazard ratio [95% confidence interval]: 1.25 [0.94-1.65], p=0.123; one-year adjusted hazard ratio [95% confidence interval]: 0.88 [0.69-1.07], p=0.128). . Conclusions: Despite a higher risk profile and poorer medical management, women present similar 30-day and one-year outcome as their male counterparts in the context of myocardial infarction network.

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Association between consumption of ultra-processed foods and all cause mortality: SUN prospective cohort study

BMJ ◽

10.1136/bmj.l1949 ◽

2019 ◽

pp. l1949 ◽

Cited By ~ 91

Author(s):

Anaïs Rico-Campà ◽

Miguel A Martínez-González ◽

Ismael Alvarez-Alvarez ◽

Raquel de Deus Mendonça ◽

Carmen de la Fuente-Arrillaga ◽

...

Keyword(s):

Cohort Study ◽

Confidence Interval ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Linear Trend ◽

Hazard Ratio ◽

Adjusted Hazard Ratio ◽

Processed Foods ◽

High Consumption ◽

All Cause Mortality

Abstract Objective To evaluate the association between consumption of ultra-processed foods and all cause mortality. Design Prospective cohort study. Setting Seguimiento Universidad de Navarra (SUN) cohort of university graduates, Spain 1999-2018. Participants 19 899 participants (12 113 women and 7786 men) aged 20-91 years followed-up every two years between December 1999 and February 2014 for food and drink consumption, classified according to the degree of processing by the NOVA classification, and evaluated through a validated 136 item food frequency questionnaire. Main outcome measure Association between consumption of energy adjusted ultra-processed foods categorised into quarters (low, low-medium, medium-high, and high consumption) and all cause mortality, using multivariable Cox proportional hazard models. Results 335 deaths occurred during 200 432 persons years of follow-up. Participants in the highest quarter (high consumption) of ultra-processed foods consumption had a higher hazard for all cause mortality compared with those in the lowest quarter (multivariable adjusted hazard ratio 1.62, 95% confidence interval 1.13 to 2.33) with a significant dose-response relation (P for linear trend=0.005). For each additional serving of ultra-processed foods, all cause mortality relatively increased by 18% (adjusted hazard ratio 1.18, 95% confidence interval 1.05 to 1.33). Conclusions A higher consumption of ultra-processed foods (>4 servings daily) was independently associated with a 62% relatively increased hazard for all cause mortality. For each additional serving of ultra-processed food, all cause mortality increased by 18%. Study registration ClinicalTrials.gov NCT02669602 .

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Association of miR-21-5p, miR-122-5p, and miR-320a-3p with 90-Day Mortality in Cardiogenic Shock

International Journal of Molecular Sciences ◽

10.3390/ijms21217925 ◽

2020 ◽

Vol 21 (21) ◽

pp. 7925

Author(s):

Mikko Hänninen ◽

Toni Jäntti ◽

Heli Tolppanen ◽

Heli Segersvärd ◽

Tuukka Tarvasmäki ◽

...

Keyword(s):

Confidence Interval ◽

Cardiogenic Shock ◽

Multivariate Regression Analysis ◽

Hazard Ratio ◽

Adjusted Hazard Ratio ◽

Coronary Syndrome ◽

All Cause Mortality ◽

Life Threatening ◽

New Biomarkers ◽

Circulating Levels

Cardiogenic shock (CS) is a life-threatening emergency. New biomarkers are needed in order to detect patients at greater risk of adverse outcome. Our aim was to assess the characteristics of miR-21-5p, miR-122-5p, and miR-320a-3p in CS and evaluate the value of their expression levels in risk prediction. Circulating levels of miR-21-5p, miR-122-5p, and miR-320a-3p were measured from serial plasma samples of 179 patients during the first 5–10 days after detection of CS, derived from the CardShock study. Acute coronary syndrome was the most common cause (80%) of CS. Baseline (0 h) levels of miR-21-5p, miR-122-5p, and miR-320a-3p were all significantly elevated in nonsurvivors compared to survivors (p < 0.05 for all). Above median levels at 0h of each miRNA were each significantly associated with higher lactate and alanine aminotransferase levels and decreased glomerular filtration rates. After adjusting the multivariate regression analysis with established CS risk factors, miR-21-5p and miR-320a-3p levels above median at 0 h were independently associated with 90-day all-cause mortality (adjusted hazard ratio 1.8 (95% confidence interval 1.1–3.0), p = 0.018; adjusted hazard ratio 1.9 (95% confidence interval 1.2–3.2), p = 0.009, respectively). In conclusion, circulating plasma levels of miR-21-5p, miR-122-5p, and miR-320a-3p at baseline were all elevated in nonsurvivors of CS and associated with markers of hypoperfusion. Above median levels of miR-21-5p and miR-320a-3p at baseline appear to independently predict 90-day all-cause mortality. This indicates the potential of miRNAs as biomarkers for risk assessment in cardiogenic shock.

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Association of baseline platelet count with all-cause mortality after acute myocardial infarction

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872620925257 ◽

2020 ◽

pp. 204887262092525 ◽

Cited By ~ 1

Author(s):

Pil Sang Song ◽

Kye Taek Ahn ◽

Jin-Ok Jeong ◽

Ki-Hyun Jeon ◽

Young Bin Song ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Acute Myocardial Infarction ◽

Platelet Count ◽

Confidence Interval ◽

Hazard Ratio ◽

Adjusted Hazard Ratio ◽

Baseline Platelet Count ◽

Increased Risk ◽

All Cause Mortality

Background We sought to evaluate baseline platelet count as a prognostic indicator in patients with acute myocardial infarction (AMI). Methods Data of 13,085 patients with AMI were retrieved from a prospective nationwide AMI registry from November 2011 to December 2015. Using Cox hazards models, cumulative risks for adverse outcomes were compared among patients with baseline platelet count of less than 150 K/µL (lowest quartile), 150 to 249 K/µL, 250 to 349 K/µL (reference) and equal to or greater than 350 K/µL (higher quartile). The primary outcome of interest was all-cause mortality. Secondary outcomes included myocardial infarction, re-hospitalisation for heart failure, and stroke. Results During a median follow-up of 2.1 years, a steep U-shaped association was observed for the occurrence of all-cause mortality ( p for non-linearity <0.001). For stroke, a similar U-shaped curve was also seen ( p for non-linearity = 0.095). After multiple adjustments, the lowest and higher quartiles of baseline platelet count were positively associated with all-cause mortality (adjusted hazard ratio: 2.120; 95% confidence interval: 1.345–3.341; p = 0.001, and adjusted hazard ratio: 1.642; 95% confidence interval: 0.957–2.817; p = 0.072, respectively). Similar results were observed in sensitivity analyses even after excluding patients with age ≥75 years or patients with heart failure. Conclusions In patients with AMI, baseline platelet count demonstrated a U-shaped association with an increased risk of all-cause mortality at two years. If validated, these findings suggest that baseline platelet count could serve as a preferred prognostic marker in AMI due to its low cost and universal availability.

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Survival rate of HIV-infected children after initiation of the antiretroviral therapy and its predictors in Ethiopia: A facility-based retrospective cohort

SAGE Open Medicine ◽

10.1177/2050312119838957 ◽

2019 ◽

Vol 7 ◽

pp. 205031211983895 ◽

Cited By ~ 1

Author(s):

Getachew Arage ◽

Mekonnen Assefa ◽

Teshager Worku ◽

Agumasie Semahegn

Keyword(s):

Antiretroviral Therapy ◽

Confidence Interval ◽

Psychosocial Support ◽

Hazard Ratio ◽

Adjusted Hazard Ratio ◽

Cd4 Count ◽

Risk Of Mortality ◽

Lower Baseline ◽

Study Participants

Objective: To determine the survival rate and predictors of HIV-infected children on antiretroviral therapy at two selected facilities in North Ethiopia. Methods: A facility-based retrospective cohort study was conducted in Debre Tabor General Hospital and Dessie Referral Hospital from December 2005 to November 2015. A total of 426 records were included in the study. Multivariable Cox proportional hazards regression model was used to identify independent predictors of survival. Results: At the end of follow-up, 97 (22.9%) HIV-infected children died and 325 (77.1%) were alive. The probabilities of survival at 12, 24, 36 and 48 months of on antiretroviral therapy were 0.91, 0.85, 0.84 and 0.80, respectively. The median survival time was 91.6 months (95% confidence interval: 89.0–94.2). Almost half (51%) of the deaths occurred within the first 2 years of treatment. Study participants who had poor adherence to antiretroviral therapy (adjusted hazard ratio = 3.0; 95% confidence interval: 1.2–7.5) and who started antiretroviral therapy with lower baseline weight-for-age Z-score (adjusted hazard ratio = 2.5; 95% confidence interval: 1.1–6.1) were significantly associated with high risk of mortality. On the other hand, study participants with a baseline CD4 count above 200 cells/mm3 (adjusted hazard ratio = 0.7; 95% confidence interval: 0.4–0.9) and those participants who had psychosocial support during follow-up (adjusted hazard ratio = 0.03; 95% confidence interval: 0.1–0.7) were significantly associated with less mortality event. Conclusion: Mortality of children on antiretroviral therapy was high. The risk of mortality is increased if the child was underweight at the commencement of antiretroviral therapy, had lower baseline CD4 count, had poor adherence to antiretroviral therapy and had no psychosocial support. Concerned stakeholders should focus on antiretroviral therapy adherence, nutritional interventions, psychological support and early initiation of antiretroviral therapy regardless of their CD4 count to enhance survival of HIV-infected children on antiretroviral therapy.

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Gait speed has comparable prognostic capability to six-minute walk distance in older patients with cardiovascular disease

European Journal of Preventive Cardiology ◽

10.1177/2047487317735715 ◽

2017 ◽

Vol 25 (2) ◽

pp. 212-219 ◽

Cited By ~ 29

Author(s):

Kentaro Kamiya ◽

Nobuaki Hamazaki ◽

Yuya Matsue ◽

Alessandro Mezzani ◽

Ugo Corrà ◽

...

Keyword(s):

Cardiovascular Disease ◽

Confidence Interval ◽

Gait Speed ◽

Older Patients ◽

Hazard Ratio ◽

Adjusted Hazard Ratio ◽

Walk Distance ◽

All Cause Mortality ◽

Minute Walk Distance ◽

Minute Walk

Background Although gait speed and six-minute walk distance are used to assess functional capacity in older patients with cardiovascular disease, their prognostic capabilities have not been directly compared. Methods The study population was identified from the Kitasato University Cardiac Rehabilitation Database and consisted of 1474 patients ≥60 years old with a mean age of 72.2 ± 7.1 years that underwent evaluation of both usual gait speed and six-minute walk distance in routine geriatric assessment between 1 June 2008–30 September 2015. Both gait speed and six-minute walk distance were determined on the same day at hospital discharge. Results Mean gait speed and six-minute walk distance in the whole population were 1.04 m/s and 381 m, respectively, and were strongly positively correlated ( r = 0.80, p < 0.001). A total of 180 deaths occurred during a follow-up of 2.3 ± 1.9 years. After adjusting for confounding factors, both gait speed (adjusted hazard ratio per 0.1 m/s increase: 0.87, 95% confidence interval: 0.81–0.93, p < 0.001) and six-minute walk distance (adjusted hazard ratio per 10-metre increase: 0.96, 95% confidence interval: 0.94–0.97, p < 0.001) were independent predictors of all-cause mortality. There was no significant difference in prognostic capability between gait speed and six-minute walk distance (c-index: 0.64 (95% confidence interval: 0.60–0.69) and 0.66 (95% confidence interval: 0.61–0.70), respectively, p = 0.357). Conclusions Gait speed and six-minute walk distance showed similar prognostic predictive ability for all-cause mortality in older cardiovascular disease patients, indicating the potential utility of gait speed as a simple risk stratification tool in older cardiovascular disease patients.

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MO526REAL-WORLD EVIDENCE ON CLINICAL OUTCOMES IN NON-DIABETIC CKD

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab087.0046 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Christoph Wanner ◽

Johannes Schuchhardt ◽

Chris Bauer ◽

Stefanie Lindemann ◽

Meike Brinker ◽

...

Keyword(s):

Clinical Outcomes ◽

Kidney Failure ◽

Time Course ◽

Kidney Injury ◽

Incidence Rates ◽

Real World Evidence ◽

Ckd Stage ◽

The Us ◽

Egfr Decline

Abstract Background and Aims Chronic kidney disease (CKD) represents a global public health problem, with significant morbidity and mortality due to cardiovascular disease during CKD progression and due to kidney failure. Although non-diabetic CKD accounts for up to 70% of the global CKD burden, its clinical consequences are poorly understood, and data are needed to help identify individuals at high risk of adverse outcomes. This analysis uses real-world evidence to provide insights into clinical characteristics, care and outcomes in individuals with non-diabetic CKD in routine clinical practice. Method Individual-level data from the US administrative claims database, Optum Clinformatics Data Mart, from January 1, 2008 to December 31, 2018 were analysed. Adults with non-diabetic CKD stage 3 or 4 and ≥365 days continuous insurance coverage were included and followed until insurance disenrollment, end of data availability or death. Individuals with diabetes mellitus, CKD stage 5 or end-stage kidney disease (ESKD) prior to the index date, or who experienced kidney failure (acute or unspecified), kidney transplant or dialysis in the baseline period, were excluded from the analysis. Study outcomes, captured in the database, were defined using common clinical coding systems. Primary outcomes were hospitalisation for heart failure (HHF), a kidney composite of ESKD/kidney failure/need for dialysis, and worsening of CKD stage from baseline. Individual CKD stage was assigned based on estimated glomerular filtration rate (eGFR) values (priority) or the respective International Classification of Diseases code at index and during follow-up. Further prespecified kidney outcomes included individual components of the kidney composite, acute kidney injury, and absolute and relative change in eGFR from baseline. Event-based outcomes were assessed by time-to-first-event analysis. Summary statistics for time-course analysis of metric outcomes were generated on a quarterly basis. Results In total, 504,924 of 64 million individuals in the Optum Clinformatics Data Mart satisfied the selection criteria. Over a median follow-up of 744 (interquartile range 328–1432) days, the incidence rates of primary outcomes of HHF, the kidney composite and worsening of CKD stage from baseline were 3.95, 10.33 and 4.38 events/100 patient-years (PY), respectively. The incidence rates of the components of the kidney composite outcome, namely ESKD/need for dialysis, kidney failure (acute and unspecified) and need for dialysis were 1.78, 9.53 and 0.49 events/100 PY, respectively. Kidney failure events were driven mainly by acute kidney injury, with an incidence of 8.61 events/100 PY. In individuals with at least one available eGFR value at baseline and one value during follow-up (n=295,174), the incidence rates of relative decreases in eGFR of ≥30%, ≥40% and ≥57% from baseline were 1.98, 0.97 and 0.30 events/100 PY, respectively; in this cohort, more rapid eGFR decline was associated with increased risk of HHF and the kidney composite outcome. In individuals with a baseline eGFR value and at least one follow-up eGFR value and an available urine albumin-to-creatinine ratio (n=25,824), time-course analysis of eGFR showed that eGFR decline mostly occurred in individuals with moderately-to-severely increased albuminuria (≥30 mg/g). Conclusion This analysis generates real-world evidence on clinical outcomes in a cohort of individuals with non-diabetic CKD treated in routine clinical practice in the US. Despite known limitations of claims databases (e.g. low availability of some laboratory data, limited individual follow-up time and tactical coding), individuals with moderate-to-severe non-diabetic CKD are shown to be at high risk of serious clinical outcomes. This highlights the high unmet medical need, and urgency for new treatments and targeted interventions for patients with non-diabetic CKD.

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Abstract WP347: Clopidogrel Plus Aspirin in Patients With Different Types of Single Small Subcortical Infarction_Subgroup Analysis of CHANCE Trial

Stroke ◽

10.1161/str.47.suppl_1.wp347 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Yilong Wang ◽

Xiaomeng Yang ◽

Jing Jing ◽

Xingquan Zhao ◽

Liping Liu ◽

...

Keyword(s):

Confidence Interval ◽

Recurrent Stroke ◽

Final Analysis ◽

Hazard Ratio ◽

Adjusted Hazard Ratio ◽

Parent Artery ◽

Bleeding Events ◽

Intention To Treat ◽

Different Types ◽

Aspirin Group

Objective: We aim to investigate the effects and safety of clopidogrel plus aspirin in patients with different types of single small subcortical infarction(SSSI) in the Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial. Methods: In this subgroup analysis, SSSI was defined as single DWI lesion of ≤2.0 cm and SSSI with stenosis of any degree of the parent artery was regarded as a SSSI+PAD. We assessed the interaction of the treatment effects of clopidogrel plus aspirin versus aspirin alone among patients with and without PAD. Efficacy was assessed by intention to treat analysis and safety was assessed in the on-treatment population. Results: A total of 338 patients with SSSI were included in the final analysis,105 with SSSI+PAD and 233 SSSI-PAD. In SSSI+PAD patients, 10.9% (5/46) had recurrent stroke in the clopidogrel-aspirin group as compared to 13.6% (8/59) in the aspirin group (adjusted hazard ratio, 0.66; 95% confidence interval, 0.20-2.20; P=0.50). In SSSI-PAD patients, 8.9% (11/124) had recurrent stroke in the clopidogrel-aspirin group as compared 7.3% (8/109) in the aspirin group (adjusted hazard ratio, 1.64; 95% confidence interval, 0.61- 4.38; P=0.32). The number of bleeding events was similar between the clopidogrel-aspirin group and aspirin group regardless of SSSI+PAD or SSSI-PAD. Conclusions: Although dual antiplatelet therapy did not significantly reduce the risk of recurrent stroke than aspirin alone in patients with SSSI. It was potentially beneficial to the patients with SSSI+PAD. Dual antiplatelet treatment did not increase the risk of bleeding in patients with any kind of SSSI.

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