Abstract: SA-PO779
The Association of Markers of Mineral Bone Disease with CVEs in Early CKD
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
- McIntyre, Natasha Juliette, Faculty of Medicine and Health Sciences, University of Nottingham, London, Ontario, Canada
- Shardlow, Adam, Royal Derby Hospital, Derby, United Kingdom
- Kolhe, Nitin V., Royal Derby Hospital, Derby, United Kingdom
- Fluck, Richard J., Royal Derby Hospital, Derby, United Kingdom
- McIntyre, Christopher W., London Health Sciences Centre, London, Ontario, Canada
- Taal, Maarten W., Faculty of Medicine and Health Sciences, University of Nottingham, London, Canada
Background
Markers of mineral bone disease (MBD), particularly FGF23 and serum phosphate, are associated with a higher risk of cardiovascular events (CVEs) in Chronic Kidney Disease (CKD). However, it is not clear if these associations exist in early CKD, when phosphate is normal and FGF23 only mildly elevated. We investigated biomarkers of MBD as risk factors for CVE in people with CKD stage 3 in primary care.
Methods
1741 people with estimated GFR 59-30mL/min/1.73m2 (eGFR) were recruited to the Renal Risk in Derby (RRID) study and assessed at baseline, year 1 and 5. Data on all hospital admissions with CVE (using ICD-10 coding) and cardiovascular deaths between 2008 to 2015 were obtained from NHS Digital. Cox regression analysis was performed on the whole cohort, those with heart failure (HF) or atherosclerotic events to identify risk factors for CVEs.
Results
608 CVEs occurred during a mean period of 5.1±2.2 years, a rate of 6.8/100 participant years. The most frequent CVE was HF (345/608=57%). In the whole cohort age, male sex, HDL cholesterol, smoking, eGFR and urinary albumin to creatinine ratio were confirmed as independent risk factors for CVEs. Among the MBD biomarkers, phosphate and PTH predicted CVEs but FGF23 and vitamin D did not. There were differences in risk factors for HF versus atherosclerotic events (Table).
Conclusion
We identified HF as the commonest CVE in those with early CKD. In addition we identified phosphate and PTH as independent risk factors for CVEs even at early stages of CKD, when there is only minor perturbation of these variables. Our findings suggest trials of interventions to lower serum phosphate in early CKD are warranted.
Comparative risk factors for CVE
| All CVEs n=608 | HF group=345 | Atherosclerotic group=263 | ||||
| Risk factor at baseline | p value | HR | p value | HR | p value | HR |
| Male sex | 0.001 | 1.424 | 0.005 | 1.458 | 0.003 | 1.58 |
| Age (yrs)* | <0.0001 | 1.385 | <0.0001 | 1.369 | <0.0001 | 1.503 |
| HDL cholesterol (mmol/l)* | 0.003 | 0.866 | 0.01 | 0.851 | 0.03 | 0.854 |
| Smoking | 0.02 | 1.24 | NS | NS | 0.006 | 1.47.2 |
| UACR (mg/mmol)* | 0.001 | 1.168 | 0.01 | 1.17 | 0.005 | 1.224 |
| eGFR CKDEPI (mL/min/1.73m2)* | 0.04 | 0.897 | 0.01 | 0.841 | NS | NS |
| Serum phosphate (mmol/l)* | 0.003 | 1.143 | 0.01 | 1.162 | 0.03 | 1.167 |
| PTH (pg/ml)* | 0.002 | 1.158 | 0.001 | 1.228 | NS | NS |
*per Standard Deviation, ‡log transformed data, HR=Hazard Ratio, UACR= Urinary albumin to creatinine ratio, PTH=Parathyroid hormone, NS=Not significant
Funding
- Private Foundation Support