title: Absolute Rates of Heart Failure, Coronary Heart Disease, and Stroke in Chronic Kidney Disease: An Analysis of 3 Community-Based Cohort Studies.
abstract: Cardiovascular disease is the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD). Understanding the relative contributions of cardiovascular disease event types to the excess burden of cardiovascular disease is important for developing effective strategies to improve outcomes.
  
  
  
  To determine absolute rates and risk differences of incident heart failure (HF), coronary heart disease (CHD), and stroke in participants with vs without CKD.
  
  
  
  We pooled participants without prevalent cardiovascular disease from 3 community-based cohort studies: the Jackson Heart Study, Cardiovascular Health Study, and Multi-Ethnic Study of Atherosclerosis. The Jackson Heart Study was conducted between 2000 and 2010, the Cardiovascular Health Study was conducted between 1989 and 2003, and the Multi-Ethnic Study of Atherosclerosis was conducted between 2000 and 2012.
  
  
  
  Chronic kidney disease was defined as estimated glomerular filtration rate less than 60 mL/min/1.73 m2, calculated using the combined creatinine-cystatin C CKD-Epidemiology Collaboration Equation.
  
  
  
  Poisson regression was used to calculate incidence rates (IRs) and risk differences of adjudicated incident HF, CHD, and stroke, comparing participants with vs without CKD.
  
  
  
  Among 14 462 participants, the mean (SD) age was 63 (12) years, 59% (n = 8533) were women, and 44% (n = 6363) were African American. Overall, 1461 (10%) had CKD (mean [SD] estimated glomerular filtration rate, 49 [10] mL/min/1.73 m2). Unadjusted IRs for participants with and without CKD, respectively, were 22.0 (95% CI, 19.3-24.8) and 6.2 (95% CI, 5.8-6.7) per 1000 person-years for HF; 24.5 (95% CI, 21.6-27.5) and 8.4 (95% CI, 7.9-9.0) per 1000 person-years for CHD; and 13.4 (95% CI, 11.3-15.5) and 4.8 (95% CI, 4.4-5.3) for stroke. Adjusting for demographics, cohort, hypertension, diabetes, hyperlipidemia, and tobacco use, risk differences comparing participants with vs without CKD (per 1000 person-years) were 2.3 (95% CI, 1.2-3.3) for HF, 2.3 (95% CI, 1.2-3.4) for CHD, and 0.8 (95% CI, 0.09-1.5) for stroke. Among African American and Hispanic participants, adjusted risk differences comparing participants with vs without CKD for HF were 3.5 (95% CI, 1.5-5.5) and 7.8 (95% CI, 2.2-13.3) per 1000 person-years, respectively.
  
  
  
  Among 3 diverse community-based cohorts, CKD was associated with an increased risk of HF that was similar in magnitude to CHD and greater than stroke. The excess risk of HF associated with CKD was particularly large among African American and Hispanic individuals. Efforts to improve health outcomes for patients with CKD should prioritize HF in addition to CHD prevention.
authors.affiliation: Kidney Research Institute, Division of Nephrology, University of Washington, Seattle.
authors.forename: Nisha
authors.initials: N
authors.lastname: Bansal
authors.affiliation: Kidney Research Institute, Division of Nephrology, University of Washington, Seattle.
authors.forename: Ronit
authors.initials: R
authors.lastname: Katz
authors.affiliation: Kidney Research Institute, Division of Nephrology, University of Washington, Seattle.
authors.forename: Cassianne
authors.initials: C
authors.lastname: Robinson-Cohen
authors.affiliation: College of Public Health and Human Services, Oregon State University, Corvallis.
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Odden
authors.affiliation: Division of Nephrology, University of California, Davis, San Francisco.
authors.forename: Lorien
authors.initials: L
authors.lastname: Dalrymple
authors.affiliation: Department of Medicine, University of California, San Francisco.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Shlipak
authors.affiliation: Division of Nephrology, Tufts Medical Center, Boston, Massachusetts.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Sarnak
authors.affiliation: New York Academy of Medicine, New York.
authors.forename: David S
authors.initials: DS
authors.lastname: Siscovick
authors.affiliation: Kidney Research Institute, Division of Nephrology, University of Washington, Seattle.
authors.forename: Leila
authors.initials: L
authors.lastname: Zelnick
authors.affiliation: Cardiovascular Health Research Unit, University of Washington, Seattle.
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Psaty
authors.affiliation: Kidney Research Institute, Division of Nephrology, University of Washington, Seattle.
authors.forename: Bryan
authors.initials: B
authors.lastname: Kestenbaum
authors.affiliation: Department of Medicine and Pediatrics, University of Mississippi Medical Center, Jackson.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Correa
authors.affiliation: Kidney Research Institute, Division of Nephrology, University of Washington, Seattle.
authors.forename: Maryam
authors.initials: M
authors.lastname: Afkarian
authors.affiliation: Kidney Research Institute, Division of Nephrology, University of Washington, Seattle9Puget Sound Veterans Affairs Administration, Washington, DC.
authors.forename: Bessie
authors.initials: B
authors.lastname: Young
authors.affiliation: Kidney Research Institute, Division of Nephrology, University of Washington, Seattle9Puget Sound Veterans Affairs Administration, Washington, DC.
authors.forename: Ian H
authors.initials: IH
authors.lastname: de Boer
mesh_terms: D001741:Black or African American; D003327:Coronary Disease / Q000208:ethnology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000208:ethnology* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000208:ethnology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000208:ethnology* / Q000209:etiology; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology