Kidney disease as a risk factor for recurrent cardiovascular disease and mortality.
BACKGROUND
Chronic kidney disease (CKD) is highly prevalent in the United States and is an independent risk factor for adverse cardiovascular disease (CVD) and all-cause mortality outcomes in patients with acute coronary syndromes. Few studies have evaluated the effect of CKD on cardiovascular events in a diverse community-based population with underlying CVD.


METHODS
Data for subjects with preexisting CVD were pooled from 4 publicly available, community-based, longitudinal studies: Atherosclerosis Risk in Communities, Cardiovascular Health Study, Framingham Heart Study, and Framingham Offspring Study. CKD was defined as an estimated glomerular filtration rate less than 60 mL/min/1.73 m2 (<1 mL/s/1.73 m2). The primary study outcome was a composite of myocardial infarction (MI), fatal coronary heart disease (CHD), stroke, and all-cause mortality. The secondary outcome included only MI and fatal CHD.


RESULTS
A total of 4,278 subjects satisfied inclusion criteria, and 759 subjects (17.7%) had CKD. Mean follow-up was 86 months. The primary and secondary outcomes were observed in 1,703 (39.8%) and 857 subjects (20.0%), respectively. Incidence rates for the primary and secondary outcomes were greater in persons with CKD compared with those without CKD (62.5% versus 34.9% and 30.6% versus 17.8%, respectively). Adjusted hazard ratios for the primary and secondary outcomes were 1.35 (95% confidence interval [CI], 1.21 to 1.52) and 1.32 (95% CI, 1.12 to 1.55), respectively.


CONCLUSIONS
The presence of CKD in a community-based population with preexisting CVD is associated with an increased risk for recurrent CVD outcomes. This increased risk persists after adjustment for traditional CVD risk factors.
Weiner
Daniel E
DE
Division of Nephrology, Tufts-New England Medical Center, Boston, MA 02111, USA.
Tighiouart
Hocine
H
Stark
Paul C
PC
Amin
Manish G
MG
MacLeod
Bonnie
B
Griffith
John L
JL
Salem
Deeb N
DN
Levey
Andrew S
AS
Sarnak
Mark J
MJ
D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology / Q000401:mortality; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology; D015994:Incidence; D007674:Kidney Diseases / Q000453:epidemiology*; D007677:Kidney Function Tests; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009203:Myocardial Infarction / Q000453:epidemiology / Q000401:mortality; D012008:Recurrence; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012959:Socioeconomic Factors; D020521:Stroke / Q000453:epidemiology; D014481:United States / Q000453:epidemiology