Predicting Cardiovascular Events in Patients With CKD
Predicting Cardiovascular Events in Patients With CKD
Background. Increased interarm systolic blood pressure difference (IASBPD) is associated with mortality and cardiovascular (CV) events both in the general population and in patients at high CV risk. The aim of the present study was to assess the value of IASBPD ≥ 10 mmHg for predicting CV events in patients with chronic kidney disease (CKD).
Methods. The study sample comprised 652 patients with CKD (age 67 ± 15 years, 58.1% men). Follow-up was 19 ± 5 months. We recorded increased IASBPD and related factors and assessed the predictive value of this variable for CV events.
Results. We recorded diabetes mellitus in 136 patients (20.8%), history of CV disease in 213 (32.6%) and dyslipidaemia in 327 (50.1%). The mean glomerular filtration rate was 45.9 ± 18.9 mL/min/1.73 m, and the median albumin/creatinine ratio was 26 (0–151) mg/g. IASBPD was ≥10 mmHg in 184 patients (28.1%). The factors associated with IASBPD ≥10 mmHg were age, systolic blood pressure levels, history of congestive heart failure, lower levels of high-density lipid cholesterol and higher use of hypertensive drugs. Fifty-eight patients (8.5%) developed a CV event during the follow-up. IASBPD ≥10 mmHg [HR, 1.802, 95%CI (1.054–3.079); P = 0.031] was an independent predictor of CV events.
Conclusions. Increased IASBPD is an independent predictor of CV events in CKD patients.
Patients with chronic kidney disease (CKD) are highly likely to develop cardiovascular (CV) events caused by traditional (e.g. hypertension, diabetes mellitus and dyslipidaemia) and non-traditional factors (e.g. inflammation, uraemia, anaemia or mineral metabolism abnormalities). Community-based studies have shown that the severity of CV risk factors correlates with the decrease in glomerular filtration rate, although subclinical abnormalities can be detected even at early stages of CKD.
An interarm systolic blood pressure difference (IASBPD) of ≥10 mmHg has been correlated with CV risk factors in the general population and in patients with specific conditions such as diabetes mellitus and vascular disease. Consequently, in those patients with comorbidities, prognosis is poor, and an IASBPD of ≥10 mmHg can predict CV events and mortality. Despite the finding of an association with all-cause mortality in CKD and non-CKD patients, the literature provides little data on IASBPD and CV disease in patients with kidney impairment. Agarwal et al. evaluated the IASBPD in a cohort of 421 veteran patients, including 218 with CKD. Overall mortality was increased in those patients having an IASBPD of ≥10 mmHg even after adjusting for the presence of CKD. However, in this study, CKD patients are not deeply analysed separately (only mortality is assessed in survival curves) and CV events are not evaluated. In addition, Okada et al. showed that IASBPD was related to the progression of diabetic kidney disease, as the development of albuminuria was independently associated to systolic blood pressure differences in type 2 diabetes patients. No data regarding CV prognosis are shown in this study.
The objective of the present study was to assess the prevalence and prognostic value of IASBPD in a cohort of CKD patients and to establish related factors.
Abstract and Introduction
Abstract
Background. Increased interarm systolic blood pressure difference (IASBPD) is associated with mortality and cardiovascular (CV) events both in the general population and in patients at high CV risk. The aim of the present study was to assess the value of IASBPD ≥ 10 mmHg for predicting CV events in patients with chronic kidney disease (CKD).
Methods. The study sample comprised 652 patients with CKD (age 67 ± 15 years, 58.1% men). Follow-up was 19 ± 5 months. We recorded increased IASBPD and related factors and assessed the predictive value of this variable for CV events.
Results. We recorded diabetes mellitus in 136 patients (20.8%), history of CV disease in 213 (32.6%) and dyslipidaemia in 327 (50.1%). The mean glomerular filtration rate was 45.9 ± 18.9 mL/min/1.73 m, and the median albumin/creatinine ratio was 26 (0–151) mg/g. IASBPD was ≥10 mmHg in 184 patients (28.1%). The factors associated with IASBPD ≥10 mmHg were age, systolic blood pressure levels, history of congestive heart failure, lower levels of high-density lipid cholesterol and higher use of hypertensive drugs. Fifty-eight patients (8.5%) developed a CV event during the follow-up. IASBPD ≥10 mmHg [HR, 1.802, 95%CI (1.054–3.079); P = 0.031] was an independent predictor of CV events.
Conclusions. Increased IASBPD is an independent predictor of CV events in CKD patients.
Introduction
Patients with chronic kidney disease (CKD) are highly likely to develop cardiovascular (CV) events caused by traditional (e.g. hypertension, diabetes mellitus and dyslipidaemia) and non-traditional factors (e.g. inflammation, uraemia, anaemia or mineral metabolism abnormalities). Community-based studies have shown that the severity of CV risk factors correlates with the decrease in glomerular filtration rate, although subclinical abnormalities can be detected even at early stages of CKD.
An interarm systolic blood pressure difference (IASBPD) of ≥10 mmHg has been correlated with CV risk factors in the general population and in patients with specific conditions such as diabetes mellitus and vascular disease. Consequently, in those patients with comorbidities, prognosis is poor, and an IASBPD of ≥10 mmHg can predict CV events and mortality. Despite the finding of an association with all-cause mortality in CKD and non-CKD patients, the literature provides little data on IASBPD and CV disease in patients with kidney impairment. Agarwal et al. evaluated the IASBPD in a cohort of 421 veteran patients, including 218 with CKD. Overall mortality was increased in those patients having an IASBPD of ≥10 mmHg even after adjusting for the presence of CKD. However, in this study, CKD patients are not deeply analysed separately (only mortality is assessed in survival curves) and CV events are not evaluated. In addition, Okada et al. showed that IASBPD was related to the progression of diabetic kidney disease, as the development of albuminuria was independently associated to systolic blood pressure differences in type 2 diabetes patients. No data regarding CV prognosis are shown in this study.
The objective of the present study was to assess the prevalence and prognostic value of IASBPD in a cohort of CKD patients and to establish related factors.
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