Background: Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in chronic kidney disease (CKD) patients with and without diabetes mellitus (DM). Traditional cardiovascular risk factors fail to fully account for the increase in cardiovascular risk in these patients. The NEFRONA study is a large, multicentre, prospective, observational study that evaluated atheromatous disease (AD) in the carotid and femoral territories in a large cohort of Spanish CKD patients without previous CVD.
Objectives: To analyse the prognostic value of subclinical AD in CKD patients with and without DM on the incidence of cardiovascular events (CVE).
Materials and methods: NEFRONA cohort data from CKD patients with DM (n=698) and without DM (n=1747) were analysed. Patients underwent baseline carotid and femoral ultrasound examinations and were followed-up for 4 years. All the CVE during the follow-up period were registered. Bivariate analysis and Fine-Gray competing risks models were used to perform the statistical analysis. Hazard ratios and 95% confidence intervals were reported.
Results: Among patients with DM, 96 CVE (13.75%) were reported during follow-up. Male gender, renal replacement therapy (RRT) and insulin treatment were more frequent in DM patients with CVE compared to those without CVE. Among CKD patients without DM, 107 CVE (6.12%) were reported. Being older, RRT and decreased serum concentrations of HDL-cholesterol were more frequent among non-DM patients with CVE. Presence of plaque, number of plaques and having more than two vascular territories affected with plaque at baseline were more frequent among CKD patients with CVE (with and without DM). Following competing risks models, the variable predicting CVE among CKD patients with DM was number of territories with plaque at baseline (1.78 (1.39, 2.28)). The variables predicting CVE in CKD patients without DM were age (1.03 (1.00, 1.05)), number of territories with plaque at baseline (1.86 (1.43, 2.42)) and serum concentrations of 25OH-vitaminD (0.96 (0.93, 0.99)).
Conclusion: Presence and burden of subclinical AD is the most potent factor to influence CVE in CKD patients with DM whereas, in CKD patients without DM, other risk factors such as age and decreased serum concentrations of 25OH-vitaminD are also associated with an increased risk of CVE. Early detection of subclinical AD and identification of AD burden through arterial ultrasound, performed at different vascular territories, could improve prediction of CVE in these patients.
19 - 22 May 2018
European Society of Endocrinology