title: Effects of Cardiovascular Events on End-Stage Renal Disease and Mortality in Patients With Chronic Kidney Disease Before Dialysis.
abstract: 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 < 0.001). Our findings suggest that the occurrence of CVEs is a potent risk factor for ESRD and mortality in CKD patients before dialysis.
authors.affiliation: Department of Nephrology, Shuuwa General Hospital, Kasukabe, Saitama, Japan.
authors.forename: Michio
authors.initials: M
authors.lastname: Kuwahara
authors.affiliation: Department of Nephrology, Shuuwa General Hospital, Kasukabe, Saitama, Japan.
authors.forename: Eriko
authors.initials: E
authors.lastname: Takehara
authors.affiliation: Department of Nephrology, Shuuwa General Hospital, Kasukabe, Saitama, Japan.
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Sasaki
authors.affiliation: Department of Nephrology, Shuuwa General Hospital, Kasukabe, Saitama, Japan.
authors.forename: Haruna
authors.initials: H
authors.lastname: Azetsu
authors.affiliation: Department of Nephrology, Shuuwa General Hospital, Kasukabe, Saitama, Japan.
authors.forename: Keita
authors.initials: K
authors.lastname: Kusaka
authors.affiliation: Department of Nephrology, Shuuwa General Hospital, Kasukabe, Saitama, Japan.
authors.forename: Satomi
authors.initials: S
authors.lastname: Shikuma
authors.affiliation: Department of Nephrology, Shuuwa General Hospital, Kasukabe, Saitama, Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Akita
mesh_terms: D000368:Aged; D001795:Blood Pressure Determination / Q000706:statistics & numerical data; D002097:C-Reactive Protein / Q000032:analysis; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D008078:Cholesterol, LDL / Q000032:analysis; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors
chemical_list: D008078:Cholesterol, LDL; D002097:C-Reactive Protein
keywords: Cardiac event; End-stage renal disease; Mortality; Peripheral artery disease; Pre-dialysis patients; Stroke