ESRD After Heart Failure, Myocardial Infarction, or Stroke in Type 2 Diabetic Patients With CKD

David M. Charytan*, Scott D. Solomon, Peter Ivanovich, Giuseppe Remuzzi, Mark E. Cooper, Janet B. McGill, Hans Henrik Parving, Patrick Parfrey, Ajay K. Singh, Emmanuel A. Burdmann, Andrew S. Levey, Dick de Zeeuw, Kai Uwe Eckardt, John J.V. McMurray, Brian Claggett, Eldrin F. Lewis, Marc A. Pfeffer

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Background How cardiovascular (CV) events affect progression to end-stage renal disease (ESRD), particularly in the setting of type 2 diabetes, remains uncertain. Study Design Observational study. Setting & Participants 4,022 patients with type 2 diabetes, anemia, and chronic kidney disease from the Trial to Reduce Cardiovascular Events With Aranesp Therapy (TREAT). Predictor Postrandomization CV events. Outcomes ESRD (defined as initiation of dialysis for >30 days, kidney transplantation, or refusal or nonavailability of renal replacement therapy) and post-ESRD mortality within 30 days and during overall follow-up after an intercurrent CV event. Limitations Population limited to clinical trial participants with diabetes and anemia. Results 155 of 652 (23.8%) ESRD cases occurred after an intercurrent CV event; 110 (16.9%) cases followed heart failure, 28 (4.3%) followed myocardial infarction, 12 (1.84%) followed stroke, and 5 (0.77%) followed multiple CV events. ESRD rate was higher within 30 days in individuals with an intercurrent CV event compared with those without an intercurrent event (HR, 22.2; 95% CI, 17.0-29.0). Compared to no intercurrent CV events, relative risks for ESRD were higher after the occurrence of heart failure overall (HR, 3.4; 95% CI, 2.7-4.2) and at 30 days (HR, 20.1; 95% CI, 14.5-27.9) than after myocardial infarction or stroke (P < 0.001). Compared with individuals without pre-ESRD events, those with ESRD following intercurrent CV events were older, were more likely to have prior CV disease, and had higher (24.4 vs 23.1 mL/min/1.73 m2; P = 0.01) baseline estimated glomerular filtration rates (eGFRs) and higher eGFRs at last measurement before ESRD (18.6 vs 15.2 mL/min/1.73 m2; P < 0.001), whereas race, sex, and medication use were similar. Post-ESRD mortality was similar (P = 0.3) with and without preceding CV events. Conclusions Most ESRD cases occurred in individuals without intercurrent CV events who had lower eGFRs than individuals with intercurrent CV events, but similar post-ESRD mortality. Nevertheless, intercurrent CV events, particularly heart failure, are strongly associated with risk for ESRD. These findings underscore the need for kidney-specific therapies in addition to treatment of CV risk factors to lower ESRD incidence in diabetes.

Original languageEnglish (US)
Pages (from-to)522-531
Number of pages10
JournalAmerican Journal of Kidney Diseases
Volume70
Issue number4
DOIs
StatePublished - Oct 2017

Keywords

  • Cardiovascular diseases
  • cerebral infarction
  • end-stage renal disease (ESRD)
  • heart failure
  • kidney
  • myocardial infarction

ASJC Scopus subject areas

  • Nephrology

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