Effects of Cardiovascular Events on End-Stage Renal Disease and Mortality in Patients With Chronic Kidney Disease Before Dialysis

• Published in: Therapeutic apheresis and dialysis 2016-02, Vol.20 (1), p.12-19
• Main Authors: Kuwahara, Michio, Takehara, Eriko, Sasaki, Yasunori, Azetsu, Haruna, Kusaka, Keita, Shikuma, Satomi, Akita, Wataru
• Format: Article
• Language: English
• Subjects: Aged; Blood Pressure Determination - statistics & numerical data; C-Reactive Protein - analysis; Cardiac event; Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - etiology; Cholesterol, LDL - analysis; End-stage renal disease; Female; Glomerular Filtration Rate; Humans; Japan - epidemiology; Kaplan-Meier Estimate; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - diagnosis; Kidney Failure, Chronic - mortality; Kidney Failure, Chronic - therapy; Male; Middle Aged; Mortality; Peripheral artery disease; Pre-dialysis patients; Proportional Hazards Models; Renal Dialysis - methods; Renal Dialysis - statistics & numerical data; Risk Factors; Stroke
• ISSN: 1744-9979; 1744-9987
• DOI: 10.1111/1744-9987.12332

Cardiovascular events (CVEs) are major complications in patients with chronic kidney disease (CKD). However, few studies have investigated the effects of CVEs on end‐stage renal disease (ESRD) and mortality of pre‐dialysis patients. We followed 377 CKD patients who were at stage ≥G3 at first clinic visit in the Shuuwa General Hospital between April 2005 and July 2014. After taking baseline patient data, we evaluated renal survival rates and all‐cause and CVE‐related mortality in patients with CVEs [(+)CVEs] and without CVEs [(−)CVEs]. A total of 99 CVEs occurred in 93 study patients (57.0% cardiac events, 43.0% cerebrovascular events, and 6.5% peripheral artery disease events). During the study period, 127 patients reached ESRD over a median of 4.51 years' follow‐up. Kaplan–Meier analysis found longer renal survival rates in the (−)CVEs group compared with the (+)CVEs group. Forty patients died during the study period over a median of 5.43 years' follow‐up. Survival rates for all‐cause and CVE‐related mortality of (−)CVEs patients were higher than in (+)CVEs patients. After adjustment for sex, age, current smoking, blood pressure, diabetes, estimated glomerular filtration rate, low‐density lipoprotein cholesterol, high‐density lipoprotein cholesterol, left ventricular hypertrophy, body mass index, albumin, hemoglobin, calcium, phosphate, C‐reactive protein, and spot urine protein, the occurrence of CVEs was still a significant risk factor for ESRD (HR 1.516, P = 0.017) and all‐cause mortality (HR 7.871, P