The risks for major adverse cardiovascular events (MACE) in patients with chronic kidney disease (CKD) increases with the number of comorbidities, according to a poster presentation at the American Society of Nephrology’s Kidney Week 2021.

In a study of 173,388 patients with CKD from Wales, UK, within the 2011-2018 SAIL databank, the risk for MACE significantly increased 1.2-, 1.4-, 1.7-, and 2.6-fold with 1, 2, 3, and 4 or more co-existing conditions, such as asthma or depression, Michael K. Sullivan, MBChB, and colleagues from the University of Glasgow in the UK, reported. MACE encompassed myocardial infarction, stroke, and heart failure hospitalization.

In secondary analyses, the investigators excluded cardiometabolic conditions, including hypertension, ischemic heart disease, cerebrovascular disease, heart failure, atrial fibrillation, peripheral vascular disease, and diabetes. Although MACE risk decreased, it nonetheless remained significantly elevated 1.2-, 1.3-, 1.4-, and 1.7-fold with 1, 2, 3, and 4 or more co-existing conditions, respectively, the investigators reported.


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The median age of the cohort was 78 years, 57% were female, and 98.6% belonged to a White ethnic group. The median estimated glomerular filtration rate (eGFR) was 51 mL/min/1.73 m2. In analyses, the team adjusted for age, sex, smoking, socioeconomic deprivation, eGFR, and cholesterol levels.

“Cardiovascular risk stratification and preventative strategies in patients with CKD should take into account the number and type of other chronic conditions,” according to Dr Sullivan’s team.

In a 2018 global health report on multimorbidity from the Academy of Medical Sciences, the authors discussed the strong link between CKD and cardiovascular disease, which “appears to be mediated, at least in part, by the clustering of traditional cardiovascular disease risk factors (such as hypertension, diabetes, and dyslipidaemia). However, it has been proposed that the clustering might also be mediated by additional risk factors unique to those with CKD, including mineral malabsorption, oxidative stress, and inflammation.”

CKD and multimorbidity also commonly lead to polypharmacy and significant treatment burden.

References

Sullivan MK, Bhautesh Dinesh J, Mair FS, Mark PB. Patients with CKD and multiple chronic conditions are at increased risk of cardiovascular events. Presented at: Kidney Week 2021; November 2-7, 2021. Abstract: PO1767.

Sullivan MK, Bhautesh Dinesh J, Mair FS, Mark PB. Associations between multimorbidity and adverse clinical outcomes in patients with chronic kidney disease: a systematic review and meta-analysis. BMJ Open. doi:10.1136/bmjopen-2020-038401

Multimorbidity: a priority for global health research. The Academy of Medical Sciences; April 2018.