Chronic kidney disease as a risk factor for abdominal aortic aneurysm: a nationwide population-based study

Abstract

Purpose: Chronic kidney disease (CKD) is a well-known risk factor for cardiovascular outcomes; however, its association with abdominal aortic aneurysm (AAA) remains unknown. To investigate this association, a national wide population study has been undertaken.

Methods: This cohort study extracted data from the Korean National Health Insurance System database for individuals who had health checkups in 2009. The incidence of AAA was ascertained through the end of 2019. The study population was classified into 4 groups based on the CKD stage: stages 1, 2, 3, and ≥4. The primary endpoint was newly diagnosed AAA.

Results: During the mean follow-up of 9.3 years, a total of 20,760 patients (0.2%) were diagnosed with AAA. The incidence rates of AAA were 0.10, 0.23, 0.67, and 1.19 per 1,000 person-years in stages 1, 2, 3, and ≥4, respectively. In Cox proportional hazard model, advanced stage of CKD was associate with an increased risk of AAA development after adjusting full covariates (hazard ratio [95% confidence interval]: 1.12 [1.07-1.67], 1.16 [1.10-1.23], and 1.3 [1.15-1.46]; CKD stage 2 to ≥4, respectively; P < 0.001). There was a positive correlation between the degree of dipstick proteinuria and the risk of AAA, which was consistent regardless of age group, sex, smoking, dyslipidemia, diabetes mellitus, and hypertension.

Conclusion: CKD demonstrated positively associated with the development of AAA, its association showed graded risk as stage of CKD advanced.

Keywords: Abdominal aortic aneurysm; Chronic kidney disease; End-stage renal disease; Hazard ratio.

Fig. 1. Flowchart of the study population. AAA, abdominal aortic aneurysm; eGFR, estimated glomerular filtration rate; CKD, chronic kidney disease.

Fig. 2. Kaplan-Meier curves for the incidence of abdominal aortic aneurysm according to the stage of chronic kidney disease (CKD). ESRD, end-stage renal disease.

Fig. 3. Subgroup analysis. Increased risk of the hazard ratio of abdominal aortic aneurysm (AAA) according to the severity of chronic kidney disease (CKD), regardless of (A) sex, (B) age group, (C) smoking, (D) diabetes mellitus, (E) hypertension, and (F) hyperlipidemia. Hazard ratios were calculated using a Cox proportional model adjusted for age and sex, smoking, alcohol consumption, regular exercise, diabetes mellitus, hypertension, hyperlipidemia, stroke, myocardial infarction, chronic obstructive pulmonary disease, body mass index, and urine protein.