MO073ACCELERATION OF KIDNEY FUNCTION DECLINE AFTER INCIDENT HOSPITALIZATION WITH CARDIOVASCULAR DISEASE: THE STOCKHOLM CREATININE MEASUREMENTS (SCREAM) PROJECT. (6th June 2020)

• Record Type: Journal Article
• Authors: Ishigami, Junichi; Trevisan, Marco; Lund, Lars; Jernberg, Tomas; Coresh, Josef; Matsushita, Kunihiro; Carrero, Juan Jesus
• Is Part Of: Nephrology dialysis transplantation. Volume 35(2020)Supplement 3
• Publication Date: 2020-06-06
• Subjects: Nephrology -- Periodicals; Hemodialysis -- Periodicals; Kidneys -- Transplantation -- Periodicals; Hemodialysis; Kidneys -- Transplantation; Nephrology; Periodicals; 616.61
• DOI: 10.1093/ndt/gfaa140.MO073
• Languages: English
• ISSNs: 0931-0509

Abstract

Abstract: Background and Aims: The cardiorenal syndrome refers to a bidirectional relationship between the kidney and the heart. However, epidemiological evidence of cardiovascular disease (CVD) as a risk factor for chronic kidney disease (CKD) progression is actually scarce. We here quantified slopes of kidney function decline before and after the incidence of major CVD. Method: We examined the slopes of estimated glomerular filtration rate (eGFR) decline in the 2 years before vs. after an incident hospitalization with heart failure (HF) (n=20, 420), coronary heart disease (CHD) (n=18, 152), or stroke (n=1, 808) using data from a complete laboratory data collection in Stockholm, Sweden between 2006 and 2011. We used mixed-effect models with unstructured residual correlation matrix and stratified by index eGFR (≥60, 30-59, <30 ml/min/1.73m 2 ). Results: Overall, patients who had HF were older, and had more comorbidities (e.g., diabetes, hypertension) and lower eGFR compared to those who had CHD or stroke. Incident hospitalization with HF and CHD, but not stroke, was significantly associated with a subsequent accelerated decline in eGFR, with a faster eGFR decline and greater slope change after HF than CHD. In the overall population, the pre-event vs. post-event eGFR slopes (ml/min/1.73m 2 per year) were -1.67 (-1.77 to -1.57) vs. -2.76 (-2.82 to -2.71), with a Δslope of -1.09 (-1.16 to -1.02) for HF; -1.09 (-1.20 to -0.98) vs. -1.87 (-1.92 to -1.81), with a Δslope of -0.78 (-0.85 to -0.70) for CHD; and -1.00 (-1.37 to -0.63) vs. -0.99 (-1.19 to -0.78), with a Δslope of 0.02 (-0.24 to 0.27) for stroke (Figure 1A ). The accelerated declines in eGFR after HF and CHD were consistent across the spectrum of eGFR, although pre-event eGFR slopes were steeper in lower eGFR (e.g., pre-event eGFR slope for HF -0.64 (-0.76 to -0.53) for eGFR ≥60, -1.43 (-1.57 to -1.30) for eGFR 30-59, and -2.42 (-2.71 to -2.12) for eGFR <30 ml/min/1.73m 2 ) (Figure B-D ). Conclusion: Incident hospitalization with cardiac diseases (i.e., HF and CHD) was significantly associated with a subsequent acceleration of eGFR decline.