Nisha Bansal1, Ronit Katz1, Cassianne Robinson-Cohen1, Michelle C Odden2, Lorien Dalrymple3, Michael G Shlipak4, Mark J Sarnak5, David S Siscovick6, Leila Zelnick1, Bruce M Psaty7, Bryan Kestenbaum1, Adolfo Correa8, Maryam Afkarian1, Bessie Young9, Ian H de Boer9. 1. Kidney Research Institute, Division of Nephrology, University of Washington, Seattle. 2. College of Public Health and Human Services, Oregon State University, Corvallis. 3. Division of Nephrology, University of California, Davis, San Francisco. 4. Department of Medicine, University of California, San Francisco. 5. Division of Nephrology, Tufts Medical Center, Boston, Massachusetts. 6. New York Academy of Medicine, New York. 7. Cardiovascular Health Research Unit, University of Washington, Seattle. 8. Department of Medicine and Pediatrics, University of Mississippi Medical Center, Jackson. 9. Kidney Research Institute, Division of Nephrology, University of Washington, Seattle9Puget Sound Veterans Affairs Administration, Washington, DC.
Abstract
Importance: 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. Objective: To determine absolute rates and risk differences of incident heart failure (HF), coronary heart disease (CHD), and stroke in participants with vs without CKD. Design, Setting and Participants: 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. Exposures: 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. Main Outcomes and Measures: 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. Results: 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. Conclusions and Relevance: 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.
Importance: 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. Objective: To determine absolute rates and risk differences of incident heart failure (HF), coronary heart disease (CHD), and stroke in participants with vs without CKD. Design, Setting and Participants: 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. Exposures: 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. Main Outcomes and Measures: 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. Results: 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. Conclusions and Relevance: 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: Marcello Tonelli; Paul Muntner; Anita Lloyd; Braden J Manns; Scott Klarenbach; Neesh Pannu; Matthew T James; Brenda R Hemmelgarn Journal: Lancet Date: 2012-06-19 Impact factor: 79.321
Authors: Brenda R Hemmelgarn; Braden J Manns; Anita Lloyd; Matthew T James; Scott Klarenbach; Robert R Quinn; Natasha Wiebe; Marcello Tonelli Journal: JAMA Date: 2010-02-03 Impact factor: 56.272
Authors: Maryam Afkarian; Michael C Sachs; Bryan Kestenbaum; Irl B Hirsch; Katherine R Tuttle; Jonathan Himmelfarb; Ian H de Boer Journal: J Am Soc Nephrol Date: 2013-01-29 Impact factor: 10.121
Authors: Kunihiro Matsushita; Josef Coresh; Yingying Sang; John Chalmers; Caroline Fox; Eliseo Guallar; Tazeen Jafar; Simerjot K Jassal; Gijs W D Landman; Paul Muntner; Paul Roderick; Toshimi Sairenchi; Ben Schöttker; Anoop Shankar; Michael Shlipak; Marcello Tonelli; Jonathan Townend; Arjan van Zuilen; Kazumasa Yamagishi; Kentaro Yamashita; Ron Gansevoort; Mark Sarnak; David G Warnock; Mark Woodward; Johan Ärnlöv Journal: Lancet Diabetes Endocrinol Date: 2015-05-28 Impact factor: 32.069
Authors: Ian H de Boer; Ronit Katz; Jie J Cao; Linda F Fried; Bryan Kestenbaum; Ken Mukamal; Dena E Rifkin; Mark J Sarnak; Michael G Shlipak; David S Siscovick Journal: Diabetes Care Date: 2009-07-08 Impact factor: 19.112
Authors: Cassianne Robinson-Cohen; Michael Shlipak; Mark Sarnak; Ronit Katz; Carmen Peralta; Bessie Young; Andrew N Hoofnagle; Moyses Szklo; Joachim H Ix; Bruce M Psaty; Ian H de Boer; Bryan Kestenbaum; Nisha Bansal Journal: J Clin Endocrinol Metab Date: 2020-04-01 Impact factor: 5.958
Authors: Nisha Bansal; Adam Szpiro; Kristi Reynolds; David H Smith; David J Magid; Jerry H Gurwitz; Frederick Masoudi; Robert T Greenlee; Grace H Tabada; Sue Hee Sung; Ashveena Dighe; Alan S Go Journal: JAMA Intern Med Date: 2018-03-01 Impact factor: 21.873
Authors: Zachary A Marcum; Christopher W Forsberg; Kathryn P Moore; Ian H de Boer; Nicholas L Smith; Edward J Boyko; James S Floyd Journal: J Gen Intern Med Date: 2017-11-27 Impact factor: 5.128
Authors: Matthew J Williams; Toshifumi Sugatani; Olga A Agapova; Yifu Fang; Joseph P Gaut; Marie-Claude Faugere; Hartmut H Malluche; Keith A Hruska Journal: Kidney Int Date: 2017-08-23 Impact factor: 10.612
Authors: Ricky Camplain; Anna Kucharska-Newton; Thomas C Keyserling; J Bradley Layton; Laura Loehr; Gerardo Heiss Journal: Am J Cardiol Date: 2018-03-01 Impact factor: 2.778