Americans with CKD more likely to have CVD, die before ESKD than Japanese counterparts
Click Here to Manage Email Alerts
Compared with Japanese patients with chronic kidney disease, Americans with CKD are more likely to experience CVD events or death before developing end-stage kidney disease, according to a published study.
Data published in Kidney International revealed the enlarged hearts of American patients could contribute to the difference, and checking the heart with echocardiography or preventing obesity and inflammation could protect patients with CKD from the enlargement.
Researchers noted that the difference in BMI was responsible for the differences in LVMI and C-reactive protein levels in the patient cohorts. Image: Adobe Stock
“Studies have shown that dialysis patients in the United States are more likely to die or to develop CVD events than their Japanese counterparts. However, little is known about patients with pre-dialysis CKD due to a dearth of direct comparisons,” Takahiro Imaizumi, MD, PhD, from the department of biostatistics, epidemiology and informatics in the Perelman School of Medicine at the University of Pennsylvania, and colleagues wrote. They added, “Among the various types of CVD, a growing number of patients develop congestive heart failure (CHF) as kidney function declines. Left ventricular (LV) structure and function are important clinical measures that are predictive of future outcomes. Several observational studies have shown that LV mass index (LVMI) or LV hypertrophy (LVH) is associated with CVD events in patients with CKD. Similarly, reduced ejection fraction (EF), even in the absence of clinical heart failure, was also shown to be associated with CVD and all-cause mortality in patients with CKD.”
Researchers examined 3,125 patients with CKD from the Chronic Renal Insufficiency Cohort (CRIC) study conducted in the U.S. and 1,097 patients with CKD from the CKD Japan Cohort (CKD-JAC) studies. Patient data included baseline echocardiography results, and researchers only utilized data from the first 5 years after baseline measures were taken. Researchers sought to compare the clinical outcomes of ESKD, CVD and death among the cohorts.
Using a mediation analysis, researchers measured the echocardiographic parameters in the differences between both cohorts, specifically with cardiovascular outcomes. Further, researchers performed Kaplan-Meier method and log-rank tests to compare CVD events, atherosclerotic CVD (ASCVD), CHF, death and ESKD between the cohorts.
Among the CRIC patients, the mean LVMI and EF were 55.7 g/m2 and 54%, respectively, whereas the CKD-JAC patients showed a mean LVMI of 46.6 g/m2 and an EF of 65%. Researchers noted that the difference in BMI was responsible for the differences in LVMI and C-reactive protein levels in the patient cohorts.
After the 5-year follow-up, patients from the CRIC study were at a higher risk for CVD and death. Researchers observed low EF and high LVMI correlated with CVD in both cohorts.
“Using patient data from the U.S. and Japan, we found that U.S. patients with CKD had higher rates of heart failure and heart attack than Japanese patients. We then aimed to clarify how this happened. Our results revealed that the enlarged hearts of U.S. patients and their weak contractility play important roles. These features explain most of the differences in cardiovascular outcomes between the U.S. and Japan,” Imaizumi and colleagues wrote. “Checking the heart with echocardiography may help identify high-risk patients. In addition, obesity and inflammation, which were related to each other, were associated with the enlargement of the heart. Therefore, countermeasures against obesity can protect patients with CKD from heart disease.”
Collapse
Read more about
Click Here to Manage Email Alerts