Association between chronic kidney disease progression and cardiovascular disease: results from the CRIC Study

Abstract

Background and aims: There is limited information on the risk of progression of chronic kidney disease (CKD) among individuals with CVD (cardiovascular disease). We studied the association between prevalent CVD and the risk of progression of CKD among persons enrolled in a long-term observational study.

Methods: A prospective cohort study of 3,939 women and men with CKD enrolled in the chronic renal insufficiency cohort (CRIC) study between June 2003 and June 2008. Prevalent cardiovascular disease (myocardial infarction/revascularization, heart failure, stroke, and peripheral vascular disease) was determined by self-report at baseline. The primary outcome was a composite of either end-stage renal disease or a 50% decline in estimated glomerular filtration rate (eGFR) from baseline.

Results: One-third (1,316 of 3,939, 33.4%) of the study participants reported a history of any cardiovascular disease, and 9.6% (n = 382) a history of heart failure at baseline. After a median follow up of 6.63 years, 1,028 patients experienced the primary outcome. The composite of any CVD at baseline was not independently associated with the primary outcome (Hazard Ratio 1.04 95% CI (0.91, 1.19)). However, a history of heart failure was independently associated with a 29% higher risk of the primary outcome (Hazard Ratio 1.29 95% CI (1.06, 1.57)). The relationship between heart failure and risk of CKD progression was consistent in subgroups defined by age, race, gender, baseline eGFR, and diabetes. Neither the composite measure of any CVD or heart failure was associated with the rate of decline in eGFR.

Conclusions: Self-reported heart failure was an independent risk factor for the development of the endpoint of ESRD or 50% decline in GFR in a cohort of patients with chronic kidney disease.

Fig 1

Legend Prevalence of self reported CVD in CRIC participants stratified by baseline eGFR (ml/min/1.73m²⁾.

Fig 2a and 2b

Legend Kaplan Meir plots of ESRD or 50% decline in eGFR by history of any CVD (Fig 2a) and heart failure (Figure 2b) at baseline (unadjusted).

Figure 3

Legend Hazard ratios of risk of ESRD or 50% decline in kidney function in patients with heart failure in subgroups based on sex, age, race, and clinical sites (Adjusted for Systolic blood pressure, triglycerides, HDL, Body Mass Index, smoking, Diabetes, eGFR, Urine protein, ACE/ARB use Hemoglobin, FGF-23).