Chronic kidney disease has a graded association with death and cardiovascular outcomes in stable coronary artery disease: an analysis of 21,911 patients from the CLARIFY registry

Vidal-Petiot, E. et al. (2019) Chronic kidney disease has a graded association with death and cardiovascular outcomes in stable coronary artery disease: an analysis of 21,911 patients from the CLARIFY registry. Journal of Clinical Medicine, 9(1), 4. (doi: 10.3390/jcm9010004)

Abstract

Chronic kidney disease (CKD) is associated with an increased cardiovascular risk in a broad spectrum of populations. However, the risk associated with a reduced estimated glomerular filtration rate (eGFR) in patients with stable coronary artery disease receiving standard care in the modern era, independently of baseline cardiovascular disease, risk factors, and comorbidities, remains unclear. We analyzed data from 21,911 patients with stable coronary artery disease, enrolled in 45 countries between November 2009 and July 2010 in the CLARIFY registry. Patients with abnormal renal function were older, with more comorbidities, and received slightly lower—although overall high—rates of evidence-based secondary prevention therapies than patients with normal renal function. The event rate of patients with CKD stage 3b or more (eGFR <45 mL/min/1.73 m2) was much higher than that associated with any comorbid condition. In a multivariable adjusted Cox proportional hazards model, lower eGFR was independently associated with a graded increased risk of cardiovascular mortality, with adjusted HRs (95% CI) of 0.98 (0.81–1.18), 1.31 (1.05–1.63), 1.77 (1.38–2.27), and 3.12 (2.25–4.33) for eGFR 60–89, 45–59, 30–44, and <30 mL/min/1.73 m2, compared with eGFR ≥90 mL/min/1.73 m2. A strong graded independent relationship exists between the degree of CKD and cardiovascular mortality in this large cohort of patients with chronic coronary artery disease, despite high rates of secondary prevention therapies. Among clinical risk factors and comorbid conditions, CKD stage 3b or more is associated with the highest cardiovascular mortality.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Kalra, Professor Paul and Greenlaw, Miss Nicola and Ford, Professor Ian

Creator Roles

Greenlaw, N.: Formal analysis, Methodology, Project administration, Writing – review and editing
Kalra, P. R.: Conceptualization, Methodology, Writing – review and editing
Ford, I.: Conceptualization, Formal analysis, Project administration, Software, Supervision, Writing – review and editing

• Authors: Vidal-Petiot, E., Greenlaw, N., Kalra, P. R., Garcia-Moll, X., Tardif, J.-C., Ford, I., Zamorano, J., Ferrari, R., Tendera, M., Fox, K. M., and Steg, P. G.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
• Journal Name: Journal of Clinical Medicine
• Publisher: MDPI
• ISSN: 2077-0383
• ISSN (Online): 2077-0383
• Copyright Holders: Copyright © 2019 The Authors
• First Published: First published in Journal of Clinical Medicine 9(1):4
• Publisher Policy: Reproduced under a Creative Commons License