CVD death common among individuals with reduced eGFR, regardless of CKD progression
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Irrespective of chronic kidney disease progression, the most common cause of death among individuals with a reduced eGFR was death due to cardiovascular disease, according to data published in Kidney Medicine.
“We conducted this study in order to better understand the major causes of death for individuals at all stages of CKD,” Nayanjot K. Rai, MPH, BDS, from the division of nephrology and hypertension at University of Minnesota Medical School, and colleagues wrote. They added, “Prior studies evaluating cause of death in CKD were limited in that they excluded patients who progressed to dialysis, evaluated kidney function only during the year prior to death, and did not account for progression of CKD. Like CKD progression, the impact of proteinuria on the distribution of causes of death has also been understudied.”
In a retrospective cohort study, researchers examined the data of two cohorts. The first included adults with CKD who received primary care at M Health Fairview (MHFV) after Dec. 31, 2012, and who were reported in the Minnesota Death Index before Dec. 31, 2019. The second cohort included adults with stable kidney function in the 1996 to 2006 National Health and Nutrition Examination Survey who were linked with the National Death Index through 2015.
With death due to CVD and malignancy- and dementia-attributed death serving as the primary outcome, researchers considered eGFR and proteinuria at baseline the exposures.
Using multinomial logistic regression, researchers determined the proportion for each death-type by kidney function category.
For people of either cohort with eGFR less than 60 mL/min/1.73 m2, death due to CVD was more common than death from malignancy. However, the opposite was true for those with higher eGFR without proteinuria.
Among the cohort with stable kidney function, those with proteinuria and eGFR at least 60 mL/min/1.73 m2 were at an increased risk for a CVD-related death. Analyses revealed that CKD progression in patients with CKD did not significantly impact the cause of death, except for dementia deaths.
Additionally, proteinuria showed insignificant effects on the relationship with cause of death across a range of eGFR levels.
“In conclusion, our study reveals that, aside from ‘other’ deaths, deaths due to CVD represent a plurality of deaths among those with baseline eGFR < 60 mL/min/1.73 m2 and remains a significant cause of death for those with eGFR 60 mL/min/1.73 m2 and proteinuria,” Rai and colleagues wrote. “CKD progression does not appear to significantly modify the relationship between CKD and likelihood of death due to CVD.”
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