title: Subclinical renal dysfunction is independently associated with cardiovascular events in rheumatoid arthritis: the CARRÉ Study.
abstract: BACKGROUND
  Patients with rheumatoid arthritis (RA) have double the risk of cardiovascular (CV) disease, largely independently of traditional CV risk factors. Renal dysfunction is associated with CV morbidity and mortality in the general population, but data on this association in RA are lacking.
  
  
  OBJECTIVE
  To investigate the association between renal function and CV events in RA.
  
  
  METHODS
  The CARRÉ Study is an ongoing prospective cohort study of Dutch patients with RA, which records CV events. Glomerular filtration rate (GFR) was estimated with the abbreviated Modification of Diet in Renal Disease formula. Logistic regression determined the association between estimated GFR and the occurrence of CV events.
  
  
  RESULTS
  353 patients were followed for 3 years, and 23 (7%) had a CV event. Patients who had an event had a significantly lower baseline GFR than those who did not (59 vs 79 ml/min, p=0.001). This association remained significant after adjustment for traditional risk factors: in this analysis, a decrease in GFR of 5 ml/min was associated with a 30% (95% CI 7% to 59%) increase in the occurrence of CV events. During follow-up, an unfavourable change in GFR was noted in patients who later had a CV event compared with those who did not.
  
  
  CONCLUSIONS
  These data confirm that, in RA, renal dysfunction is associated with a higher risk of CV disease independently of traditional CV risk factors.
authors.affiliation: Department of Rheumatology, Jan van Breemen Research Institute/Reade, Amsterdam, The Netherlands.
authors.forename: A M
authors.initials: AM
authors.lastname: van Sijl
authors.forename: I A M
authors.initials: IA
authors.lastname: van den Oever
authors.forename: M J L
authors.initials: MJ
authors.lastname: Peters
authors.forename: M
authors.initials: M
authors.lastname: Boers
authors.forename: B A C
authors.initials: BA
authors.lastname: Dijkmans
authors.forename: V P
authors.initials: VP
authors.lastname: van Halm
authors.forename: Y M
authors.initials: YM
authors.lastname: Smulders
authors.forename: A E
authors.initials: AE
authors.lastname: Voskuyl
authors.forename: M T
authors.initials: MT
authors.lastname: Nurmohamed
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D004812:Epidemiologic Methods; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009426:Netherlands