+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Chronic kidney disease, prevalence of premature cardiovascular disease, and relationship to short-term mortality



Chronic kidney disease, prevalence of premature cardiovascular disease, and relationship to short-term mortality



American Heart Journal 156(2): 277-283



Chronic kidney disease (CKD) is recognized as an independent cardiovascular disease (CVD) risk state, particularly in the elderly, and has been defined by levels of estimated glomerular filtration rate (eGFR) and markers of kidney damage. The relationship between CKD and CVD in younger and middle-aged adults has not been fully explored. Community volunteers completed surveys regarding past medical events and underwent blood pressure and laboratory testing. Chronic kidney disease was defined as an eGFR <60 mL x min(-1) x 1.73 m(-2) or urine albumin-creatinine ratio (ACR) > or =30 mg/g. Premature CVD was defined as self-reported myocardial infarction or stroke at <55 years of age in men and <65 years of age in women. Mortality was ascertained by linkage to national data systems. Of 31 417 participants, the mean age was 45.1 +/- 11.2 years, 75.5% were female, 36.8% African American, and 21.6% had diabetes. A total of 20.6% were found to have CKD, with the ACR and eGFR being the dominant positive screening tests in the younger and older age deciles, respectively. The prevalences of premature myocardial infarction (MI), stroke, or death, and the composite were 5.3%, 4.7%, 0.8%, 9.2%, and 2.5%, 2.2%, 0.2%, 4.2% for those with and without CKD, respectively (P < .0001 for composite). Multivariable analysis found CKD (OR 1.44, 95% CI 1.27-1.63), age (OR 1.05 [per year], 95% CI 1.04-1.06), hypertension (OR 1.61, 95% CI 1.40-1.84), diabetes (OR 2.03, 95% CI 1.79-2.29), smoking (OR 1.91, 95% CI 1.66-2.21), and less than high school education (OR 1.59, 95% CI 1.37-1.85) as the most significantly associated factors for premature CVD or death (all P < .0001). Survival analysis found those with premature MI or stroke and CKD had the poorest short-term survival over the next 3 years after screening. Chronic kidney disease is an independent predictor of MI, stroke, and death among men and women younger than age 55 and 65 years, respectively. These data suggest the biologic changes that occur with kidney failure promote CVD at an accelerated rate that cannot be fully explained by conventional risk factors or older age. Screening for CKD by using both the ACR and eGFR can identify younger and middle-aged individuals at high risk for premature CVD and near-term death.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 030538155

Download citation: RISBibTeXText

PMID: 18657657

DOI: 10.1016/j.ahj.2008.02.024


Related references

Chronic kidney disease and the short-term risk of mortality and amputation in patients hospitalized for peripheral artery disease. Journal of Vascular Surgery 58(4): 966-971, 2013

Prevalence, incidence and associated mortality of cardiovascular disease in patients with chronic kidney disease in low- and middle-income countries: a protocol for a systematic review and meta-analysis. Bmj Open 7(8): E016412, 2018

Prevalence and risk factors for cardiovascular disease among chronic kidney disease patients: results from the Chinese cohort study of chronic kidney disease (C-STRIDE). Bmc Nephrology 18(1): 23, 2017

Chronic kidney disease and cardiovascular disease--using the ANNA Standards and Practice Guidelines to improve care. Part 1: the epidemiology of chronic kidney disease: the risk factors and complications that contribute to cardiovascular disease. Nephrology Nursing Journal 33(6): 666-74; Quiz 675-6, 2007

Acute kidney injury after non-cardiovascular surgery: risk factors and impact on development of chronic kidney disease and long-term mortality. Current Medical Research and Opinion 34(10): 1829-1837, 2018

Chronic kidney disease, all-cause mortality and cardiovascular mortality among Chinese patients with established cardiovascular disease. Journal of Atherosclerosis and Thrombosis 17(4): 395-401, 2010

Infection in advanced chronic kidney disease leads to increased risk of cardiovascular events, end-stage kidney disease and mortality. Kidney International 90(4): 897-904, 2017

Statin Use during Hospitalization and Short-Term Mortality in Acute Ischaemic Stroke with Chronic Kidney Disease. European Neurology 79(5-6): 296-302, 2018

Chronic kidney disease: a public health priority and harbinger of premature cardiovascular disease. Journal of Internal Medicine 268(5): 456-467, 2010

Chronic kidney disease and risk for premature cardiovascular disease. 2007

Long-term trends in the prevalence of chronic kidney disease and the influence of cardiovascular risk factors in Norway. Kidney International 90(3): 665-673, 2017

Metabolic syndrome, components, and cardiovascular disease prevalence in chronic kidney disease: findings from the Chronic Renal Insufficiency Cohort (CRIC) Study. American Journal of Nephrology 33(6): 477-484, 2011

Detection of chronic kidney disease in patients with or at increased risk of cardiovascular disease - A science advisory from the American Heart Association Kidney and Cardiovascular Disease Council; the councils on high blood pressure research, cardiovascular disease in the young, and epidemiology and prevention; and the quality of care and outcomes research interdisciplinary working group. Circulation 114(10): 1083-1087, 2006

Current drug development challenges in chronic kidney disease (CKD)--identification of individualized determinants of renal progression and premature cardiovascular disease (CVD). Nephrology, Dialysis, Transplantation 27 Suppl 3: Iii81-8, 2013

Short-term renal hemodynamic effects of tolvaptan in subjects with autosomal dominant polycystic kidney disease at various stages of chronic kidney disease. Kidney International 84(6): 1278-1286, 2013