Kidney Week

Abstract: SA-PO783

Albuminuria, Reduced Kidney Function, and the Risk of ST and Non-ST Elevation Myocardial Infarction

Session Information

• CKD: Epidemiology, Risk Factors, Prevention - III
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 1901 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• De Chickera, Sonali Natasha, The Ottawa Hospital and Kidney Research Centre - Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada

Sonali Natasha De Chickera,

• Lam, Ngan, University of Alberta, Edmonton, Alberta, Canada

Ngan Lam,

• Silver, Samuel A., Queen's University, Kingston, Ontario, Canada

Samuel A. Silver,

• Molnar, Amber O., McMaster University, Hamilton, Ontario, Canada

Amber O. Molnar,

• Clark, Edward George, The Ottawa Hospital and Kidney Research Centre - Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada

Edward George Clark,

• Sood, Manish M., Ottawa Hospital Research Institute, Ottawa, Ontario, Canada

Manish M. Sood,

Background

Myocardial infarctions (MIs) in patients with chronic kidney disease (CKD) are associated with high rates of mortality and complications. CKD is a recognized risk factor for cardiovascular disease, but whether the risk of ST-elevation MI (STEMI) and non-ST-elevation MI (NSTEMI) differs in the CKD population is unknown. We examined the association of CKD (defined by reduced estimated glomerular filtration rate (eGFR) or albuminuria) with risks of STEMI and NSTEMI.

Methods

Using administrative data from Ontario, Canada, we examined older individuals (≥66 years of age) with an outpatient eGFR and albuminuria measure for incident MI from 2002 to 2015. Multivariate Fine & Gray sub-distribution hazards (sHR), adjusted for demographics, comorbidities, health resource utilization and medications, accounting for the competing risk of death were used.

Results

In 248,438 patients with over 1.2 million person-years of follow-up, STEMI, NSTEMI and death occurred in 1,436 (0.58%), 4,431 (1.78%) and 30,015 (12.08%) patients, respectively. In adjusted models, both eGFR and urine albumin to creatinine ration (ACR) were associated with STEMI and NSTEMI (P<0.0001). The highest level of ACR (>30 mg/mmol) was associated with a two-fold higher adjusted risk of both STEMI and NSTEMI among patients with eGFR ≥60 ml/min/1.73m² compared to ACR <3 mg/mmol. The lowest level of eGFR (<30 ml/min/1.73m²) with ACR < 3 mg/mmol was not associated with higher STEMI risk but a four-fold higher risk of NSTEMI compared to eGFR ≥60ml/min/1.73m². The lowest eGFR (<30 ml/min/1.73m²) and highest ACR (>30 mg/mmol) was associated with a greater than four-fold higher risk of both STEMI and NSTEMI (sHR (95% CI) 4.53 (3.30-6.21) and 4.42 (3.67-5.32), respectively) compared to ACR <3 mg/mmol and eGFR ≥60 ml/min/1.73m².

Conclusion

Elevations in albuminuria are associated with a higher risk of both NSTEMI and STEMI, regardless of kidney function, whereas reduced kidney function with minimal albuminuria is associated with only a heightened NSTEMI risk.