Incident Hospitalization with Major Cardiovascular Diseases and Subsequent Risk of ESKD: Implications for Cardiorenal Syndrome.

TitleIncident Hospitalization with Major Cardiovascular Diseases and Subsequent Risk of ESKD: Implications for Cardiorenal Syndrome.
Publication TypeJournal Article
Year of Publication2020
AuthorsIshigami J, Cowan LT, Demmer RT, Grams ME, Lutsey PL, Carrero J-J, Coresh JJ
Secondary AuthorsMatsushita K
JournalJ Am Soc Nephrol
Volume31
Issue2
Pagination405-414
Date Published2020 02
ISSN1533-3450
KeywordsAged, Cardio-Renal Syndrome, Cardiovascular Diseases, Female, Hospitalization, Humans, Kidney Failure, Chronic, Male, Middle Aged, Proportional Hazards Models, Prospective Studies, Risk, Stroke Volume
Abstract

BACKGROUND: Cardiorenal syndrome is a well known concept, bolstered by extensive investigations of CKD as a risk factor of cardiovascular disease. However, data on whether cardiovascular disease increases long-term risk of ESKD are sparse.

METHODS: We assessed the association of incident hospitalization with major cardiovascular diseases (heart failure, atrial fibrillation, coronary heart disease, and stroke) with subsequent risk of ESKD among individuals enrolled in the Atherosclerosis Risk in Communities study; the analysis included 9047 individuals without prevalent cardiovascular disease at their fourth study visit. Each relevant incident cardiovascular disease event was entered into multivariable Cox proportional hazard models as a time-varying exposure to estimate hazard ratios.

RESULTS: During a median follow-up of 17.5 years, there were 2598 cases of hospitalization with cardiovascular disease (heart failure, =1269; atrial fibrillation, =1337; coronary heart disease, =696; and stroke, =559) and 210 cases of incident ESKD. The incidence of major cardiovascular disease was associated with increased risk of ESKD, with the highest risk for heart failure (hazard ratio, 11.40; 95% confidence interval, 8.38 to 15.50), followed by coronary heart disease, atrial fibrillation, and stroke. When we analyzed heart failure with preserved ejection fraction and heart failure with reduced ejection fraction separately, the risk was nominally higher for heart failure with preserved ejection fraction.

CONCLUSIONS: Major incident cardiovascular disease events were associated with ESKD, independent of kidney risk factors. In particular, heart failure showed a very strong association with ESKD. Our findings highlight the importance of monitoring and managing kidney disease in patients with cardiovascular disease. The potentially distinct contribution to ESKD of heart failure with preserved versus reduced ejection fraction deserves future investigation.

DOI10.1681/ASN.2019060574
Alternate JournalJ Am Soc Nephrol
PubMed ID31919105
PubMed Central IDPMC7003293
Grant ListHHSN268201700001I / HL / NHLBI NIH HHS / United States
HHSN268201700002I / HL / NHLBI NIH HHS / United States
HHSN268201700003I / HL / NHLBI NIH HHS / United States
HHSN268201700005I / HL / NHLBI NIH HHS / United States
HHSN268201700004I / HL / NHLBI NIH HHS / United States