ESRD after heart failure, myocardial infarction, or stroke in type 2 diabetic patients with CKD

Charytan, D. M. et al. (2017) ESRD after heart failure, myocardial infarction, or stroke in type 2 diabetic patients with CKD. American Journal of Kidney Diseases, 70(4), pp. 522-531. (doi: 10.1053/j.ajkd.2017.04.018) (PMID:28599901)

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Background: How cardiovascular (CV) events affect progression to end-stage renal disease (ESRD), particularly in the setting of type 2 diabetes, remains uncertain. Study Design: Observational study. Setting & Participants: 4,022 patients with type 2 diabetes, anemia, and chronic kidney disease from the Trial to Reduce Cardiovascular Events With Aranesp Therapy (TREAT). Predictor: Postrandomization CV events. Outcomes: ESRD (defined as initiation of dialysis for >30 days, kidney transplantation, or refusal or nonavailability of renal replacement therapy) and post-ESRD mortality within 30 days and during overall follow-up after an intercurrent CV event. Limitations: Population limited to clinical trial participants with diabetes and anemia. Results: 155 of 652 (23.8%) ESRD cases occurred after an intercurrent CV event; 110 (16.9%) cases followed heart failure, 28 (4.3%) followed myocardial infarction, 12 (1.84%) followed stroke, and 5 (0.77%) followed multiple CV events. ESRD rate was higher within 30 days in individuals with an intercurrent CV event compared with those without an intercurrent event (HR, 22.2; 95% CI, 17.0-29.0). Compared to no intercurrent CV events, relative risks for ESRD were higher after the occurrence of heart failure overall (HR, 3.4; 95% CI, 2.7-4.2) and at 30 days (HR, 20.1; 95% CI, 14.5-27.9) than after myocardial infarction or stroke (P < 0.001). Compared with individuals without pre-ESRD events, those with ESRD following intercurrent CV events were older, were more likely to have prior CV disease, and had higher (24.4 vs 23.1 mL/min/1.73 m2; P = 0.01) baseline estimated glomerular filtration rates (eGFRs) and higher eGFRs at last measurement before ESRD (18.6 vs 15.2 mL/min/1.73 m2; P < 0.001), whereas race, sex, and medication use were similar. Post-ESRD mortality was similar (P = 0.3) with and without preceding CV events. Conclusions: Most ESRD cases occurred in individuals without intercurrent CV events who had lower eGFRs than individuals with intercurrent CV events, but similar post-ESRD mortality. Nevertheless, intercurrent CV events, particularly heart failure, are strongly associated with risk for ESRD. These findings underscore the need for kidney-specific therapies in addition to treatment of CV risk factors to lower ESRD incidence in diabetes.

Item Type:Articles
Keywords:Cardiovascular diseases, cerebral infarction, end-stage renal disease (ESRD), heart failure, kidney, myocardial infarction.
Glasgow Author(s) Enlighten ID:McMurray, Professor John
Authors: Charytan, D. M., Solomon, S. D., Ivanovich, P., Remuzzi, G., Cooper, M. E., McGill, J. B., Parving, H.-H., Parfrey, P., Singh, A. K., Burdmann, E. A., Levey, A. S., de Zeeuw, D., Eckardt, K.-U., McMurray, J. J.V., Claggett, B., Lewis, E. F., and Pfeffer, M. A.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:American Journal of Kidney Diseases
ISSN (Online):1523-6838
Published Online:07 June 2017

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