Study of the effect of chronic kidney disease on the incidence of cardiovascular events in a native Spanish population

Abstract

Aims: To evaluate the relationship between chronic kidney disease and the patient's cardiovascular risk measured through the incidence of major adverse cardiovascular events in a sample of Spanish population.

Design and methods: The sample consisted of 2,668 subjects. Mean age was 50.6±14.5 years and 54.6% were female. In all, 3.5% of subjects had a glomerular filtration rate (GFR) below 60ml/min and 4.3% a urinary albumin excretion (UAE) above 30mg/g. GFR was estimated from serum creatinine using the CKD-EPI equation. UAE was measured in first morning urine sample as mg/g of creatinine. We examined the multivariable association between the estimated GFR and the risks of cardiovascular events and death. The median follow-up was 81 (75-89) months.

Results: In CKD patients the hazard ratio (HR) was 1.36 (95% CI 0.97-1.91) (P=.079) for cardiovascular events and 1.62 (95% CI 0.53-4.91) (P=.396) for cardiovascular mortality. Increased UAE was also associated with higher cardiovascular risk (HR 2.38; 95% CI 1.51-3.74; P<.001) as well as increased cardiovascular mortality (HR 4.78; 95% CI 2.50-9.11; P<.001). For patients with UAE between 30 and 300mg/g HR for cardiovascular events was 2.09 (95% CI 1.34-3.50; P=.005) and 3.80 (95% CI 1.81-7.96; P<.001) for cardiovascular mortality.

Conclusions: An independent association was found between reduced GFR and cardiovascular event incidence and mortality. Increased UAE showed a higher prognostic value than decreased GFR. Our findings highlight the clinical and public health importance of routinely measuring UAE.

Keywords: Cardiovascular disease; Chronic kidney disease; Enfermedad cardiovascular; Enfermedad renal crónica; Excreción urinaria de albúmina; Urinary albumin excretion.