Cardiovascular, thromboembolic events more closely tied to kidney vs. glomerular disease
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Key takeaways:
- Rates of first-time cardiovascular and thromboembolic events in children were 3% and 2%, respectively.
- During the same period, cumulative rates of these events in adults were 10% and 5%, respectively.
Incident cardiovascular and thromboembolic events may be more closely linked to the severity of kidney disease than with glomerular disease subtype, according to results of a prospective study.
“Chronic kidney disease and albuminuria are well-established risk factors for cardiovascular (CV) disease in children and adults,” Shikha Wadhwani, MD, MS, of the Northwestern Feinberg School of Medicine in Chicago, wrote with colleagues. They added, “At the same time, risk for thromboembolic (TE) events is high in patients with [glomerular disease] GD, especially in the presence of nephrotic syndrome, yet large-scale studies characterizing the frequency and risk factors for TE events in children and adults with GD are lacking.”
Researchers analyzed data from 2,545 patients to describe cardiovascular and thromboembolic outcomes. The CureGN cohort trial included children and adults with biopsy-proven minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, IgA nephropathy or vasculitis. Exposures were eGFR, proteinuria, serum albumin, tobacco use, BMI, hypertension and renin-angiotensin-aldosterone system.
During a median follow-up of 4.6 years, the cumulative incidence of first-time cardiovascular events post-biopsy was 3% in children vs. 10% in adults. During the same period, the cumulative incidence of first-time thromboembolic events was 2% in children vs. 5% in adults, according to the findings. There was no link between glomerular disease subtype risk for primary outcomes.
Older patients and Black patients were at higher risk for both cardiovascular and thromboembolic events. For Black patients, the hazard ratio for cardiovascular events was 1.62 and was 2.25 for thromboembolic events, Wadhwani and colleagues found.
In addition, lower eGFR, higher urine protein-to-creatinine ratio (UPCR) and lower serum albumin at enrollment were tied to a higher risk of first-time cardiovascular and thromboembolic events. For each 10 mL/min/1.73m2 decrease in eGFR, the risk of a cardiovascular event increased, according to the researchers. Meanwhile, for every increase in UPCR and decrease in serum albumin, the risk of a thromboembolic event increased.
“Novel to our study is the finding of increased TE risk with self-reported Black race, and further work is needed to understand the reasons for this association,” Wadhwani and colleagues wrote. They added, “While the short-term clinical focus should target modifiable risk factors via existing pharmacologic or lifestyle interventions, longer-term goals need to aim for precision-based strategies to lessen the burden of these serious complications of GD.”
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