Role of renal function in cardiovascular risk assessment: A retrospective cohort study in a population with low incidence of coronary heart disease.
Early-stage chronic kidney disease (CKD), a marker of cardiovascular risk, is susceptible to therapeutic intervention but need further study in populations with low incidence of coronary heart disease (CHD). Incorporating glomerular filtration rate (GFR) could improve cardiovascular risk prediction in these patients.



To determine if decreased GFR is associated with increased risk of cardiovascular morbidity and all-cause mortality and to analyse GFR effect on cardiovascular risk prediction in a population with low CHD incidence.



Retrospective, observational, population-based study of 1,081,865 adults (35-74years old). Main exposure variable: GFR.



CHD, cerebrovascular disease, cardiovascular diseases, all-cause mortality. Association between GFR categories of CKD (G1-G5) and outcomes was tested with Cox survival models. G1 was defined as the reference category. Predictive value of GFR was evaluated by integrated discrimination improvement (IDI) and net reclassification improvement (NRI) indices.



Beginning at stage-3a CKD, increased risk was observed for coronary (HR 1.27 (95%CI 1.14-1.43)), cerebrovascular (HR 1.19 (95%CI 1.06-1.34)), cardiovascular (HR 1.23 (95%CI 1.13-1.34)) and all-cause mortality risk (HR 1.17 (95%CI 1.07-1.27)). GFR did not increase discrimination and reclassification indices significantly for any outcome.



In general population with low CHD incidence and stage-3 CKD, impaired GFR was associated with increased risk of all cardiovascular diseases studied and all-cause mortality, but adding GFR values did not improve cardiovascular risk calculation. Despite a four-fold higher rate of CHD incidence at GFR G3a compared to G1, this represents moderate cardiovascular risk in our context.
Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; ISV Research Group, Research Unit in Primary Care, Primary Care Services, Girona, Catalan Institute of Health (ICS), Catalunya, Spain; TransLab Research Group, Department of Medical Sciences, School of Medicine, University of Girona, Spain.
Maria
M
García-Gil
Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; ISV Research Group, Research Unit in Primary Care, Primary Care Services, Girona, Catalan Institute of Health (ICS), Catalunya, Spain.
Dídac
D
Parramon
Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; ISV Research Group, Research Unit in Primary Care, Primary Care Services, Girona, Catalan Institute of Health (ICS), Catalunya, Spain.
Marc
M
Comas-Cufí
Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; ISV Research Group, Research Unit in Primary Care, Primary Care Services, Girona, Catalan Institute of Health (ICS), Catalunya, Spain; Girona Biomedical Research Institute (IDIBGI), ICS, Catalunya, Spain.
Ruth
R
Martí
Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; ISV Research Group, Research Unit in Primary Care, Primary Care Services, Girona, Catalan Institute of Health (ICS), Catalunya, Spain; Girona Biomedical Research Institute (IDIBGI), ICS, Catalunya, Spain.
Anna
A
Ponjoan
Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; ISV Research Group, Research Unit in Primary Care, Primary Care Services, Girona, Catalan Institute of Health (ICS), Catalunya, Spain.
Lia
L
Alves-Cabratosa
Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; ISV Research Group, Research Unit in Primary Care, Primary Care Services, Girona, Catalan Institute of Health (ICS), Catalunya, Spain.
Jordi
J
Blanch
University College London, Department of Primary Care and Population Health, Rowland Hill Street, London NW3 2PF, UK.
Irene
I
Petersen
Cardiovascular, Epidemiology and Genetics Research Group, IMIM (Hospital del Mar Research Institute), Barcelona, Spain.
Roberto
R
Elosua
Cardiovascular, Epidemiology and Genetics Research Group, IMIM (Hospital del Mar Research Institute), Barcelona, Spain.
María
M
Grau
Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; Cardiovascular, Epidemiology and Genetics Research Group, IMIM (Hospital del Mar Research Institute), Barcelona, Spain; MACAP Renal Research Group, Research Unit in Primary Care, Primary Care Services, Costa Ponent. Catalan Institute of Health, Catalunya, Spain.
Betlem
B
Salvador
Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; ISV Research Group, Research Unit in Primary Care, Primary Care Services, Girona, Catalan Institute of Health (ICS), Catalunya, Spain; TransLab Research Group, Department of Medical Sciences, School of Medicine, University of Girona, Spain; Girona Biomedical Research Institute (IDIBGI), ICS, Catalunya, Spain. Electronic address: ramos.girona.ics@gencat.cat.
Rafel
R
Ramos
D015415:Biomarkers; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000209:etiology; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment
D015415:Biomarkers
Cardiovascular risk assessment; Electronic medical records; Glomerular filtration rate; Primary care