Cardiovascular risk is similar in patients with glomerulonephritis compared to other types of chronic kidney disease: a matched cohort study.
BACKGROUND
Patients with chronic kidney disease (CKD) due to glomerulonephritis (GN) are thought to be at high risk for cardiovascular disease (CVD). However, no study has examined whether GN directly contributes to CV risk beyond the effects conferred by pre-existing traditional risk factors and level of renal function.


METHODS
Matched cohort study using the previously described prospective CanPREDDICT study cohort. 2187 patients with CKD (eGFR 15-45 ml/min/m2) from 25 Canadian centres were divided into GN vs non-GN cause of CKD. Patients on immunotherapy for GN were not included in the study. Standardized measures of CV risk factors, biomarkers and CV outcomes were recorded over 3 years of follow-up, with the primary outcome measure being time to first all-cause CV event.


RESULTS
In the overall cohort, CV events occurred in 25 (8.7%) of the GN group and 338 (17.8%) of the non-GN group (HR 0.45, 95% CI 0.30-0.67, p < 0.01). In a Cox regression multivariable model that included age, sex, prior diabetes and CVD, baseline eGFR and onset of renal replacement therapy, the risk of CV events was similar in the GN and non-GN groups (HR 0.71, 95% CI 0.47-1.08, p = 0.11). GN and non-GN patients were matched by age and using a propensity score including sex, prior diabetes and CVD and baseline eGFR. In the matched group, the risk of CV events was similar in GN vs non-GN patients (N = 25/271 (9.2%) in both groups, HR 1.01, 95% CI 0.05-1.77, p = 0.9). An interaction analysis showed that CRP, ACR and troponin conferred differing amounts of CV risk in the GN and non-GN groups.


CONCLUSIONS
Patients with advanced CKD due to GN have a high 8.7% absolute 3-year risk of CVD, attributable to prior CV risk factors and level of kidney function rather than the GN disease itself.
Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia. holly.hutton@monash.edu.|Dept of Nephrology, Monash Health, 246 Clayton Rd, Clayton, VIC, 3168, Australia. holly.hutton@monash.edu.
Holly L
HL
Hutton
Division of Nephrology, University of British Columbia, Vancouver, BC, Canada.|BC Provincial Renal Agency, Vancouver, BC, Canada.|Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, BC, Canada.
Adeera
A
Levin
Division of Nephrology, University of British Columbia, Vancouver, BC, Canada.|Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, BC, Canada.
Jagbir
J
Gill
BC Provincial Renal Agency, Vancouver, BC, Canada.
Ognjenka
O
Djurdjev
BC Provincial Renal Agency, Vancouver, BC, Canada.
Mila
M
Tang
Division of Nephrology, University of British Columbia, Vancouver, BC, Canada.|BC Provincial Renal Agency, Vancouver, BC, Canada.|Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, BC, Canada.
Sean J
SJ
Barbour
D017677:Age Distribution; D002170:Canada / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology*; D015984:Causality; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005921:Glomerulonephritis / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000453:epidemiology*; D018570:Risk Assessment; D017678:Sex Distribution; D015996:Survival Rate
Cardiovascular disease; Chronic kidney disease; Glomerulonephritis