Cardiovascular mortality in patients with advanced chronic kidney disease with and without diabetes: a nationwide cohort study

Cardiovascular Diabetology

Research

Christian Torp-Pedersen¹  Gunnar Gislason²  Jesper Hastrup Svendsen³  Thomas Peter Almdal⁴  Dea Haagensen Kofod⁵  Nicholas Carlson⁵  Ellen Freese Ballegaard⁵  Bo Feldt-Rasmussen⁶  Mads Hornum⁶ 

[1] Department of Cardiology, Copenhagen University Hospital – North Zealand, Hilleroed, Denmark;Department of Public Health, University of Copenhagen, Copenhagen, Denmark;Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark;Department of Cardiology, Copenhagen University Hospital – Herlev and Gentofte, Gentofte, Denmark;Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark;Department of Cardiology, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark;Department of Endocrinology, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark;Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark;Department of Nephrology, Copenhagen University Hospital – Rigshospitalet, Inge Lehmanns vej 7, 2100, Copenhagen, Denmark;Department of Nephrology, Copenhagen University Hospital – Rigshospitalet, Inge Lehmanns vej 7, 2100, Copenhagen, Denmark;Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark;

关键词: Chronic kidney disease;    Cardiovascular mortality;    Diabetes;    Albuminuria;    Cholesterol;    Hemoglobin;   

DOI  :  10.1186/s12933-023-01867-8

 received in 2023-03-22, accepted in 2023-05-27,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundCardiovascular mortality and the impact of cardiac risk factors in advanced chronic kidney disease (CKD) remain poorly investigated. We examined the risk of cardiovascular mortality in patients with advanced CKD with and without diabetes as well as the impact of albuminuria, plasma hemoglobin, and plasma low-density lipoprotein (LDL) cholesterol levels.MethodsIn a Danish nationwide registry-based cohort study, we identified persons aged ≥ 18 years with an estimated glomerular filtration rate < 30 mL/min/1.73m2 between 2002 and 2018. Patients with advanced CKD were age- and sex-matched with four individuals from the general Danish population. Cause-specific Cox regression models were used to estimate the 1-year risk of cardiovascular mortality standardized to the distribution of risk factors in the cohort.ResultsWe included 138,583 patients with advanced CKD of whom 32,698 had diabetes. The standardized 1-year risk of cardiovascular mortality was 9.8% (95% CI 9.6–10.0) and 7.4% (95% CI 7.3–7.5) for patients with and without diabetes, respectively, versus 3.1% (95% CI 3.1–3.1) in the matched cohort. 1-year cardiovascular mortality risks were 1.1- to 2.8-fold higher for patients with diabetes compared with those without diabetes across the range of advanced CKD stages and age groups. Albuminuria and anemia were associated with increased cardiovascular mortality risk regardless of diabetes status. LDL-cholesterol was inversely associated with cardiovascular mortality risk in patients without diabetes, while there was no clear association in patients with diabetes.ConclusionsDiabetes, albuminuria, and anemia remained important risk factors of cardiovascular mortality whereas our data suggest a limitation of LDL-cholesterol as a predictor of cardiovascular mortality in advanced CKD.

【 授权许可】

CC BY   
© The Author(s) 2023

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