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
Por:
Vidal-Petiot, E, Greenlaw, N, Kalra, PR, Garcia-Moll, X, Tardif, JC, Ford, I, Zamorano, J, Ferrari, R, Tendera, M, Fox, KM, Steg, PG
Publicada:
1 ene 2020
Resumen:
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 m(2)) 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 m(2), compared with eGFR >= 90 mL/min/1.73 m(2). 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.
Filiaciones:
Vidal-Petiot, E:
Univ Paris, Paris, France
Hop Bichat Claude Bernard, AP HP, Physiol Dept, F-75018 Paris, France
Ctr Rech Inflammat, Inst Natl Sante & Rech Med INSERM U1149, F-75018 Paris, France
Greenlaw, N:
Univ Glasgow, Robertson Ctr Biostat, Glasgow G12 8QQ, Lanark, Scotland
Kalra, PR:
Portsmouth Hosp NHS Trust, Portsmouth PO6 3LY, Hants, England
Garcia-Moll, X:
Hosp Santa Creu & Sant Pau, Barcelona 08041, Spain
Tardif, JC:
Univ Montreal, Montreal Heart Inst, Montreal, PQ H1T 1C8, Canada
Ford, I:
Univ Glasgow, Robertson Ctr Biostat, Glasgow G12 8QQ, Lanark, Scotland
Zamorano, J:
Univ Hosp Ramon & Cajal, Madrid 28040, Spain
Ferrari, R:
Univ Ferrara, Ctr Cardiol, I-44124 Cona, FE, Italy
Maria Cecilia Hosp, GVM Care & Res, I-48033 Cotignola, RA, Italy
Tendera, M:
Med Univ Silesia, Sch Med Katowice, Dept Cardiol & Struct Heart Dis, PL-40055 Katowice, Poland
Fox, KM:
Imperial Coll, Royal Brompton Hosp, Natl Heart & Lung Inst, London SW3 6NP, England
Steg, PG:
Univ Paris, Paris, France
Imperial Coll, Royal Brompton Hosp, Natl Heart & Lung Inst, London SW3 6NP, England
Hop Bichat Claude Bernard, AP HP, Cardiol Dept, French Alliance Cardiovasc Trials,INSERM U1148, F-75018 Paris, France
Green Published, Green Accepted, gold
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