Specific changes found on kidney biopsy may predict increased risk of major adverse cardiovascular events (MACE) in patients with chronic kidney disease (CKD), independently of proteinuria and estimated glomerular filtration rate, investigators report.
“Histologic lesions in the kidney may reflect or contribute to systemic processes that may lead to adverse cardiovascular events,” Sushrut S. Waikar, MD, MPH, of Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine in Massachusetts, and colleagues wrote in JAMA Surgery.
In The Boston Kidney Biopsy Cohort, 597 patients underwent an indicated kidney biopsy. Over a median 5.5 years of follow-up, 126 patients experienced the primary composite outcome of death or incident MACE comprising myocardial infarction, stroke, or heart failure hospitalization.
Cardiovascular risk varied by CKD etiology and histopathologic phenotypes. In fully adjusted models, patients with nonproliferative glomerulopathy, kidney vascular diseases, and diabetic nephropathy had significant 2.6-, 2.9-, and 3.6-fold increased risks of the primary composite outcome, compared with a reference group of patients with proliferative glomerulonephritis. The presence of mesangial expansion and arteriolar sclerosis on kidney biopsy were significantly associated with 3.0- and 1.7-fold increased risk of the composite outcome. Compared with minimal chronicity, the presence of mild and severe chronicity were significantly associated with a 2.2- and 2.5-fold increased risk of the primary composite outcome.
These findings provide important insights into heart-kidney physiology, according to Dr Waikar’s team. Further studies are needed to determine whether mesangial expansion is an instigator of cardiac effects or a consequence of upstream processes affecting both the kidney and the heart. They noted that hypertension and diabetes remain important to the development of cardiovascular disease in patients with CKD.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Buckley LF, Schmidt IM, Verma A, et al. Associations between kidney histopathologic lesions and incident cardiovascular disease in adults with chronic kidney disease. JAMA Surg. Published online March 8, 2023. doi:10.1001/jamacardio.2023.0056