A JEYARUBAN1,2,3, WE HOY1,2, A CAMERON1,2, HG HEALY1,2,3, J ZHANG1,2, A MALLETT1,2,3
1CKD.QLD and NHMRC CKD.CRE, Brisbane, Australia, 2Faculty of Medicine, The University of Queensland, Herston, Australia, 3Kidney Health Service, Royal Brisbane and Women’s Hospital, Herston, Australia
Aim: To investigate the association of cardiovascular events (CVE) on deterioration of renal function in patients with chronic kidney disease (CKD).
Background: The association of CKD and CVE is well publicised. How CVE modify the pattern and rate of subsequent deterioration of renal function is not well described.
Method: A retrospective cohort study of 1,123 RBWH patients enrolled in the CKD.QLD registry from January 2011 to August 2017 with a minimum of 2 years follow up time. Patients’ CVE data and renal function (eGFR CKD-EPI) were extracted from the clinical records. Patients on renal replacement therapy (RRT) were imputed an eGFR 8mL/min/1.73m² at the date of the first treatment. Delta eGFR(mL/min/1.73m²/year, CKD-EPI) was calculated (difference between latest eGFR compared to eGFR at time of CVE incident) and stratified by quartiles.
Results: 222 patients experienced at least one CVE with ischaemic heart disease in 144, stroke in 51 and peripheral vascular disease in 40. There was no significant change in the absolute mean delta eGFR between patients with CVE and without CVE (-2.6mL/min/1.73m²/year (SE=0.4) vs -1.7mL/min/1.73 m²/year (SE=0.2); p=0.2), after adjustment for age. There was also no significant association of CVE to either first or fourth quartile of delta eGFR (48.9% vs 51.1%; p=0.4). Furthermore, when adjusting for age, gender and previous cardiovascular events there was no significant difference in the progression of RRT in patients with CVE compared to patients without CVE (11.5% vs 10.4%; p=0.6).
Conclusion: Incident CVE do not seem to have a significant association with progression i.e. differential rate of decline of renal dysfunction in CKD patients.
Andrew Jeyaruban is currently a medical registrar with a keen interest in renal medicine. He graduated from James Cook University with Honours in 2014. Andrew then completed his residency at the Royal Brisbane and Women’s Hospital Brisbane, Australia. He is currently a basic physician trainee at the Liverpool Hospital, Sydney