Cardiovascular disease in chronic kidney disease: data from the Kidney Early Evaluation Program (KEEP)

Abstract

Diabetes mellitus (DM) and hypertension (HTN) are leading joint risk factors for both cardiovascular disease (CVD) and chronic kidney disease (CKD). In the nationwide KEEP (Kidney Early Evaluation Program) an estimated glomerular filtration rate less than 60 mL/min/1.73 m(2) or a urine albumin:creatinine ratio ≥30 mg/g (3.4 mg/mmol) defines CKD. Overall in KEEP, the rates of identified CKD and self-reported CVD are 25.7% and 22.1%, respectively. The presence of CKD has been associated with younger ages of self-reported myocardial infarction and stroke. The combination of CVD and CKD in KEEP has been associated with shorter survival time. Finally, the presence of CVD or a prior history of coronary revascularization has been associated with modestly better rates of CVD risk factor control; however, the majority of patients with CKD have suboptimally controlled blood pressure, glucose, or lipids. These data suggest that patients with CKD are not only at higher risk for CVD and subsequent mortality, but are also ideal for targeted community--and practice-based interventions to improve risk factor control and, hopefully, reduce rates of subsequent cardiovacular events.

Fig. 1

Rates of self-reported cardiovascular disease (CVD) in KEEP (Kidney Early Evaluation Program) by chronic kidney disease (CKD) status according to age group, gender, and race/ethnicity. CVD indicates any of the following cardiac events: heart attack, bypass surgery, heart angioplasty, stroke, heart failure, abnormal heart rhythm, or peripheral vascular disease. (Adapted from National Kidney Foundation [28])

Fig. 2

Rates of premature myocardial infarction (MI), stroke, or death in KEEP (Kidney Early Evaluation Program). CKD—chronic kidney disease; (From McCullough et al. [4]; with permission

Fig. 3

Awareness of hypertension (a), diabetes (b), and elevated cholesterol (c) at the time of the KEEP (Kidney Early Evaluation Program) screening. (From National Kidney Foundation [28]; with permission)

Fig. 4

Rates of achieving one, two, or all three preventive cardiology goals according to chronic kidney disease (CKD) status for patients by coronary artery disease (CAD) status: no CAD, CAD but no revascularization, percutaneous coronary intervention (PCI), and coronary artery bypass graft surgery (CABG). (Preventive cardiology goals: systolic blood pressure <130 mm Hg, glucose <125 mg/dL [6.9 mmol/L] if diabetic, or total cholesterol <200 mg/dL [5.2 mmol/L]). (N=58,945. All paired P values between no CKD and CKD: no CAD, P<0.0001; CAD but no revascularization, P<0.0001; prior PCI, P= 0.033; prior CABG, P=0.0931; both PCI and CABG, P=0.2798; any revascularization [PCI or CABG], P=0.0057). (From McCullough et al. [11•]; with permission)