Kidney lesions correlate with risk for heart disease in patients with CKD
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The presence of kidney lesions correlates with a risk for heart disease in patients who have chronic kidney disease, according to data published in JAMA Cardiology.
Further, patients with mesangial expansion, kidney arteriolar sclerosis and more severe chronic histopathologic changes were at an increased risk for cardiovascular events and death.
“The kidneys and the heart are organs that talk to each other extensively and directly,” Leo F. Buckley, PharmD, from the department of pharmacy at Brigham and Boston Medical Center, said in the release. “Our study helps to illustrate more clearly how the kidney itself relates to the heart. We studied this directly by looking at a piece of tissue collected from the kidney to see if lesions on it are associated with different types of heart disease.”
In a prospective observational cohort study, researchers examined tissue from 597 participants without a history of myocardial infarction, stroke or heart failure from the Boston Kidney Biopsy Cohort.
With semiquantitative severity scores for kidney histopathologic lesions, a modified kidney pathology chronicity score and primary clinicopathologic diagnostic categories serving as exposures, researchers considered the composite of death or incident major adverse cardiovascular events (MACE) to be the outcome of the study.
Using Cox proportional hazards models, researchers measured the correlation of histopathologic lesions and scores with cardiovascular events. The models were adjusted for demographic characteristics, clinical risk factors, eGFR and proteinuria.
Researchers used the race-dependent eGFR equation that was clinically used at the time of enrollment but is no longer the standard equation.
“Our purpose wasn't to tackle the issue of race and kidney function head on, but our findings do illustrate the problems associated with race-based equations,” Buckley said in the release. “We get around the issues with eGFR and go straight to the kidneys. Rather than estimating how well a patient’s kidneys are functioning based on how old they are, what gender they are and their race, we just look at their kidneys and identify the damage there.”
During a median of 5.5 years of follow-up, a total of 126 participants experienced the composite of death or incident MACE. Researchers observed a correlation between an increased risk for heart disease and excess buildup of substances in the kidney filtration unit’s mesangium, as well as thickening of walls of small blood vessels. Further, patients with diagnoses of vascular kidney disease, diabetic kidney disease or a greater severity of chronic kidney lesions correlated with an increased risk for cardiovascular events.
“We found that people who had diabetes that was severe and long enough to lead to kidney damage also had a high risk [for] heart disease,” Buckley said in the release. “We really connected the heart, the kidneys and diabetes together.”
References:
- Buckley LF, et al. JAMA Cardiol. 2023;doi:10.1001/jamacardio.2023.0056.
- Kidney lesions associated with risk of heart disease in chronic kidney disease patients (press release). Available at: https://www.eurekalert.org/news-releases/981806. Published March 8, 2023. Accessed March 9, 2023.
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