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Study links likelihood of CVD with specific causes of ESKD
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The rate of cardiovascular disease in patients who initiate dialysis varies by cause of kidney failure, Stanford and Baylor researchers recently reported.
“Determining the underlying reasons for these differences might provide new insights into cardiovascular disease mechanisms, as well as inform future drug development and clinical trial design,” Michelle M. O’Shaughnessy, MD, and colleagues wrote.
Using U.S. Renal Data System data, researchers examined the rate of cardiovascular and cerebrovascular events after dialysis initiation among patients with ESKD attributed to any one of eight causes, including focal segmental glomerulosclerosis, IgA nephropathy, membranous nephropathy, membranoproliferative glomerulonephritis, lupus nephritis, or vasculitis, diabetic nephropathy or autosomal dominate polycystic kidney disease (ADPKD). Data from patients who had Medicare Parts A and B as their primary insurance within the first 90 days after dialysis initiation were included.
“After adjusting for demographics, socioeconomic factors, comorbidities, dialysis modality and laboratory values, cardiovascular event (hazard ratios) differed significantly by cause of ESRD,” the authors wrote. Among the 658,168 patients identified in the USRDS data, composite event rates ranged from 3.5/100 person-years in IgA nephropathy to 14.6/100 person-years in diabetic nephropathy. Comparing to IgA nephropathy, the adjusted hazard ratio was highest for diabetic nephropathy (aHR = 2.97), followed by lupus nephritis (aHR = 1.86), and thereafter ranged from 1.29 in ADPKD to 1.67 in membranous nephropathy.
“Previously, cardiovascular event rates in patients with specific subtypes of glomerular disease were reported to be higher than in the general population,” the authors wrote. “However, whether this represents a glomerular disease-specific effect or is instead attributable to more general features common to all causes of kidney disease (eg impaired kidney function, proteinuria, metabolic derangements) has not been examined.”
The authors wrote the study affirmed that patients with ESRD treated with dialysis had high cardiovascular event rates.
“Importantly, we have shown that relative hazards for cardiovascular events differ considerably by cause of ESRD. Although we cannot determine the exact underlying reasons for these differences, our data strongly support the presence of independent disease-specific influences,” the authors wrote. – by Mark E. Neumann
Disclosures: The researchers report no relevant financial disclosures.
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