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Kidney disease plays major role in cardiovascular deaths

By 2013, cardiovascular deaths attributed to reduced kidney function outnumbered kidney failure deaths globally, suggesting that early detection and treatment of chronic kidney disease may be necessary to decrease these deaths, according to data published in Journal of the American Society of Nephrology.

‘The burden of health loss and premature mortality within the [chronic kidney disease] population to CVD is less known,” Bernadette Thomas, MD, MS, clinical assistant professor of global health at University of Washington, and colleagues wrote. “Understanding the true societal impact of [chronic kidney disease] requires evaluating the independent burden of [end-stage renal disease] and reduced [glomerular filtration rate]-associated CVD. Such data would guide national priorities regarding the benefit of early [chronic kidney disease] detection.”

This research follows a recent a study in JAMA that indicated significant gaps existed in kidney disease worldwide, and that primary care providers could play an important role in addressing this shortfall.

To determine the impact of chronic kidney disease on cardiovascular health, researchers assessed the prevalence of reduced glomerular filtration rate (GFR) categories 3, 4 and 5 for 188 countries at six time points from 1990 to 2013 as part of the Global Burden of Disease Study. They used pooled random effects meta-analysis to calculate relative risks of cardiovascular outcomes by three categories of reduced GFR. The study presented results as deaths for outcomes of CVD and end-stage renal disease (ESRD) and as disability-adjusted life years (DALYs) for outcomes of CVD, GFR categories 3, 4 and 5 and ESRD.

Thomas and colleagues estimated that in 2013, reduced kidney function was associated with 2.2 million deaths, or 4% of deaths globally (95% uncertainty interval [UI]: 2-2.4 million). The results showed that 1.2 million deaths were attributed to cardiovascular deaths (95% UI: 1.1-1.4 million) and 0.96 million were ESRD-related deaths (95%: UI: 0.81-1 million). Almost 52 million DALYs were associated with reduced GFR, attributing to 2.1% of total worldwide DALYs in 2013.

Researchers observed that reduced GFR-associated cardiovascular deaths have increased by 33.8% since 1990 (95% UI: 24.6-43.8). Since 1990, DALYs attributed to high fasting glucose, high total cholesterol and high BP have all increased compared with other metabolic risk factors. Out of all super-regions, Latin America/Caribbean had the highest reduced GFR and ESRD mortality rate in 2013.

“The death rate from ESRD is increasing throughout the world and is a leading cause of death in world regions such as Central Latin America. Efforts to forestall such rates will involve detecting [chronic kidney disease] earlier,” Thomas and colleagues wrote. “In order to evaluate whether screening methods should be recommended for the general population, further cost-effectiveness analyses will need to be conducted that incorporate the 1.2 million reduced GFR attributable [CVD] deaths.” – by Savannah Demko

Disclosure : The researchers report no relevant financial disclosures.