Patients with cardiovascular disease (CVD) are at increased risk for end-stage kidney disease (ESKD), but the magnitude of risk varies according to vascular disease location, according to investigators.
In a study of 8402 patients with stable CVD, the overall incidence rate of ESKD over a median follow-up of 8.6 years was 0.9 per 1000 person-years, Helena Bleken Østergaard, MD, PhD candidate at University Medical Center Utrecht in Utrecht, The Netherlands, and colleagues reported in the Journal of Nephrology. Patients with polyvascular disease had the highest rate (1.8 per 1000 person-years), followed by patients with peripheral artery disease (1.2 per 1000 person-years). The rates were 0.6 per 1000 person-years for patients with either coronary artery disease or cerebrovascular disease.
In addition, investigators identified risk factors that were significantly and independently associated with ESKD, including type 2 diabetes, smoking, higher systolic blood pressure, lower estimated glomerular filtration rate, and higher urine albumin-to-creatinine ratio. Waist circumference, body mass index, non-HDL cholesterol, and exercise were not independently associated with ESKD risk, Dr Østergaard and colleagues reported.
“These findings highlight the potential of risk factor management in this high-risk patient group not only to prevent recurring vascular disease, but also to reduce progression to ESKD,” the authors concluded. “This is particularly important when discussing risk factor management with patients and may enhance shared decision making by showing the importance of lifestyle changes and medication in the prevention of both recurrent CVD and ESKD.”
Østergaard HB, Westerlink J, Verhaar MC, et al. End-stage kidney disease in patients with clinically manifest vascular disease; incidence and risk factors: results from the UCC-SMART cohort study. Published online March 13, 2021. J Nephrol. doi:10.1007/s40620-021-00996-1