Chronic kidney disease is major risk factor for future coronary events

By Andrew Czyzewski

People with chronic kidney disease have a 10-year risk for myocardial infarction of around 12%, report researchers who found that this was higher than that for people with diabetes.

Based on these findings, Marcello Tonelli (University of Alberta, Edmonton, Canada) and colleagues suggest that "chronic kidney disease could be added to the list of criteria defining people at highest risk of future coronary events."

The US National Cholesterol Education Program Adult Treatment Panel III (ATP III) guidelines classify diabetes as a coronary heart disease risk equivalent - ie, people with the disorder have a risk for coronary events similar to that for people with previous myocardial infarction.

People with chronic kidney disease have high rates of cardiovascular events, particularly when proteinuria is present; however, whether chronic kidney disease constitutes a coronary heart disease risk equivalent (compared with accepted criteria such as diabetes) is unknown.

In the current study, the researchers analyzed estimated glomerular filtration rates (eGFRs) and levels of proteinuria in a population-based cohort of 1,268,029 participants from Alberta, Canada.

For the primary analysis, baseline chronic kidney disease was defined as an eGFR 15-59.9 mL/min per 1.73 m² (stage 3 or 4 disease).

Tonelli et al report that during a median follow-up period of 48 months, 11,340 (1%) participants were admitted to hospital with myocardial infarction. The unadjusted rate of myocardial infarction was highest in people with previous myocardial infarction (18.5 per 1000 person-years).

In people without previous myocardial infarction, the rate of myocardial infarction was lower in those with diabetes (without chronic kidney disease) than in those with chronic kidney disease (without diabetes; 5.4 per 1000 person-years vs 6.9 per 1000 person-years).

Furthermore, when chronic kidney disease was defined by an eGFR of less than 45 mL/min per 1.73 m² and severely increased proteinuria, the rate of incident myocardial infarction rose to 12.4 per 1000 person-years.

Tonelli et al note that diabetes alone and chronic kidney disease alone (with or without proteinuria) do not increase the rate of myocardial infarction to the same extent as a history of coronary disease, and the findings therefore "do not support the use of the term coronary heart disease risk equivalent for either disorder."

Nevertheless, they conclude in The Lancet: "the risks of both myocardial infarction and all-cause death in people with both diabetes and chronic kidney disease were similar to or higher than those in people with previous myocardial infarction."

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