Chronic Kidney Disease and Cardiovascular Mortality - An Ignored Risk Factor
Journal: Advances in Medicine and Engineering Interdisciplinary Research DOI: 10.32629/ameir.v2i3.2599
Abstract
Objectives: The aim is to determine hidden chronic kidney disease (CKD) and its relationship with the appearance of cardiovascular events (CVD) and mortality. Furthermore, the aim is to identify cardiovascular risk factors (CVRF) and calculate the control degree of diabetes mellitus (DM) type 2 and dyslipidemia (DLP) prior to CVD. Material and methods: It consists of a retrospective cohort study carried out in the Basic Health Zones (BHZ) of San Agustín, (population of 33.321 users) which consists of the health centers San Agustín, Illes Columbretes, and the auxiliary clinics of Borriol and Raval; and on the other hand, the BHZ of Almassora (25,831 users), calculated in analysis between January 2015 and December 2018. The main variables were CKD, CVD, mortality and CVRFs. Results: The final sample consisted of 243 patients from two cohorts: 135 without CKD and 99 with CKD (including 36.4% of occult CKD cases). The hazard ratio (HR) of developing CVD was 4.28 and mortality was 12.3 in the group with CKD compared to the group without CKD. Regarding the relationship of CVRFs prior to the appearance of CVD, in the cohort with CKD, hypertension (HTN), DLP, and type 2 DM had significant results, compared to the cohort without CKD. Likewise, in the CKD cohort, the percentage of DLP control was less than 50.0%, and greater than 66.66% in type 2 DM. Conclusions: It is observed that a third of patients are not diagnosed with CKD, which has a high probability of developing CVD or death. Given the lack of diagnosis, interventions in the control of DLP and type 2 DM are lower.
Keywords
chronic kidney disease (CKD); cardiovascular disease (CVD); mortality; primary health care; disease prevention
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[3] White SL, Polkinghorne KR, Atkins RC, Chadban SJ. 2010. Comparison of the prevalence and mortality risk of CKD in Australia using the CKD Epidemiology Collaboration (CKDEPI) and Modification of Diet in Renal Disease (MDRD) Study GFR estimating equations: the AusDiab (Australian Diabetes, Obesity and Lifestyle) Study. Am J Kidney Dis, 55:660-70. https://doi.org/10.1053/j.ajkd.2009.12.011.
[4] Chronic kidney disease prognosis consortium, Matsushita K, van der Velde M, Astor BC, Woodward M, Levey AS, et al. 2010. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet, 375:2073-81. https://doi.org/10.1016/S0140-6736(10)60674-5.
[5] Matsushita K, Ballew SH, Coresh J. 2016. Cardiovascular risk prediction in people with chronic kidney disease. Curr Opin Nephrol Hypertens, 25:518-23. https://doi.org/10.1097/MNH.0000000000000265.
[6] Glassock RJ, Warnock DG, Delanaye P. 2017. The global burden of chronic kidney disease: estimates, variability and pitfalls. Nat Rev Nephrol, 13:104-14. https://doi.org/10.1038/nrneph.2016.163.
[7] Hill NR, Fatoba ST, Oke JL, Hirst JA, O'Callaghan CA, Lasserson DS, et al. 2016. Global prevalence of chronic kidney disease - a systematic review and meta-analysis. PloS One, 11, e0158765. https://doi.org/10.1371/journal.pone.0158765.
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[9] Gansevoort RT, Correa-Rotter R, Hemmelgarn BR, Jafar TH, Heerspink HJL, Mann JF, et al. 2013. Chronic kidney disease and cardiovascular risk: epidemiology, mechanisms, and prevention. Lancet, 382:339-52. https://doi.org/10.1016/S0140-6736(13) 60595-4.
[10] Chadban SJ, Briganti EM, Kerr PG, Dunstan DW, Welborn TA, Zimmet PZ, et al. 2003. Prevalence of kidney damage in Australian adults: the AusDiab kidney study. J Am Soc Nephrol, 14:S131-8. https://doi.org/10.1097/01.asn.0000070152.11927.4a.
[11] Stevens PE. 2013. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med, 158:825. https://doi.org/10.7326/0003-4819-158-11-201306040- 00007.
[12] Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, et al. 2003. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American heart association councils on kidney in cardiovascular disease, high blood pressure research, clinical cardiology, and epidemiology and prevention. Hypertension, 42:1050-65. https://doi.org/10.1161/01.HYP.0000102971.85504.7c.
[13] Roberts MA, Hare DL, Ratnaike S, Ierino FL. 2006. Cardiovascular biomarkers in CKD: pathophysiology and implications for clinical management of cardiac disease. Am J Kidney Dis, 48:341-60. https://doi.org/10.1053/j.ajkd.2006.06.005.
[14] Levey AS, Atkins R, Coresh J, Cohen EP, Collins AJ, Eckardt K-U, et al. 2007. Chronic kidney disease as a global public health problem: approaches and initiatives - a position statement from Kidney Disease Improving Global Outcomes. Kidney Int, 72: 247-59. https://doi.org/10.1038/sj.ki.5002343.
[15] Weiner DE, Tabatabai S, Tighiouart H, Elsayed E, Bansal N, Griffith J, et al. 2006. Cardiovascular outcomes and all-cause mortality: exploring the interaction between CKD and cardiovascular disease. Am J Kidney Dis, 48:392-401. https://doi.org/10.1053/j.ajkd.2006.05.021.
[16] Kon S, Konta T, Ichikawa K, Asahi K, Yamagata K, Fujimoto S, et al. 2018. Association between renal function and cardiovascular and all-cause mortality in the community-based elderly population: results from the Specific Health Check and Guidance Program in Japan. Clin Exp Nephrol, 22:346-52. https://doi.org/10.1007/s10157-017-1455-0.
[17] Go AS, Chertow GM, Fan D, McCulloch CE, Hsu C-Y. 2004. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med, 351: 1296-305. https://doi.org/10.1056/NEJMoa041031.
[18] Martín de Francisco ÁL, Aguilera García L, Fuster Carulla V. 2009. Enfermedad cardiovascular, enfermedad renal y otras enfermedades crónicas. Es necesaria una intervención más temprana en la enfermedad renal crónica. Aten Primaria, 41:511-4. https://doi.org/10.1016/j.aprim.2008.12.007.
[19] Martin de Francisco ÁL, Fresnedo GF, Palomar R, Piñera C, Arias M. 2005. The renal benefits of a healthy lifestyle. Kidney Int Suppl, 68:S2-6. https://doi.org/10.1111/j.1523- 1755.2005.09901.x.
[20] Manjunath G, Tighiouart H, Ibrahim H, MacLeod B, Salem DN, Griffith JL, et al. 2003. Level of kidney function as a risk factor for atherosclerotic cardiovascular outcomes in the community. J Am Coll Cardiol, 41:47-55. https://doi.org/10.1016/s0735-1097(02)02663-3.
[21] Abrass CK. 2004. Overview: obesity: what does it have to do with kidney disease? J Am Soc Nephrol, 15:2768-72. https://doi.org/10.1097/01.ASN.0000141963.04540.3E.
[22] Vallianou NG, Mitesh S, Gkogkou A, Geladari E. 2018. Chronic kidney disease and cardiovascular disease: is there any relationship? Curr Cardiol Rev, 15:55-63. https://doi. org/10.2174/1573403x14666180711124825.
[23] FLJ Visseren, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, et al, ESC Scientific Document Group. 2021. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J, 42(34):3227-337. https://doi.org/ 10.1093/eurheartj/ehab484.
[24] Salvador-González B, Gil-Terrón N, Cerain-Herrero MJ, Subirana I, Güell-Miró R, Rodríguez-Latre LM, et al. 2018. Estimated glomerular filtration rate, cardiovascular events and mortality across age groups among individuals older than 60 years in southern Europe. Rev Esp Cardiol (Engl Ed), 71:450-7. https://doi.org/10.1016/j. rec.2017.09.010.
[25] Shepherd J, Kastelein JJP, Bittner V, Deedwania P, Breazna A, Dobson S, et al. 2008. Intensive lipid lowering with atorvastatin in patients with coronary heart disease and chronic kidney disease: the TNT (Treating to New Targets) study. J Am Coll Cardiol, 51: 1448-54. https://doi.org/10.1016/j.jacc.2007.11.072.
[26] Stel VS, Brück K, Fraser S, Zoccali C, Massy ZA, Jager KJ. 2017. International differences in chronic kidney disease prevalence: a key public health and epidemiologic research issue. Nephrol Dial Transplant, 32. https://doi.org/10.1093/ndt/gfw420 ii129-35.
[27] McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2022. Guía ESC 2021 sobre el diagnóstico y tratamiento de la insuficiencia cardiaca aguda y crónica. Rev Esp Cardiol, 75:523.e1-523.e114. https://doi.org/10.1016/j. recesp.2021.11.027.
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