Kidney Week

Abstract: TH-PO214

The Association Between Subclinical Reductions in Kidney Function and Major Adverse Cardiovascular Events in Young Adults: A Population-Based Retrospective Cohort Study

Session Information

• Hypertension and CVD: Clinical - I
  November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Hypertension and CVD

• 1602 Hypertension and CVD: Clinical

Authors

• Sood, Manish M., University of Ottawa School of Epidemiology and Public Health, Ottawa, Ontario, Canada

Manish M. Sood,

• Hussain, Junayd, University of Ottawa School of Epidemiology and Public Health, Ottawa, Ontario, Canada

Junayd Hussain,

• Canney, Mark, University of Ottawa School of Epidemiology and Public Health, Ottawa, Ontario, Canada

Mark Canney,

• Elliott, Meghan J., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada

Meghan J. Elliott,

• Hundemer, Gregory L., University of Ottawa School of Epidemiology and Public Health, Ottawa, Ontario, Canada

Gregory L. Hundemer,

• Tangri, Navdeep, University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada

Navdeep Tangri,

Background

Cardiovascular risk factors and disease in young adults (18-39 years) are on the rise. Whether early reductions in kidney function (i.e., estimated glomerular filtration rate [eGFR] above the current accepted threshold for chronic kidney disease [>60 mL/min/1.73m²], but below age-expected values) are associated with elevated risk is unknown. We aim to examine age-specific associations of subclinical eGFR reductions in young adults with major adverse cardiovascular events (MACE).

Methods

We conducted a retrospective cohort study of 8.7 million individuals (3.6 million aged 18-39 years) using linked provincial healthcare datasets from Ontario, Canada from January 2008-March 2021. Cox models examined the association of categorized eGFR (50-120 mL/min/1.73m²) with MACE (first of cardiovascular mortality, acute coronary syndrome, ischemic stroke) and MACE-plus-heart failure (MACE+), stratified by age (18-39, 40-49, 50-65 years).

Results

In our cohort (mean age 41.3, mean eGFR 104.2, median follow-up 9.2 years), a stepwise increase in the relative risk of MACE and MACE+ was observed as early as eGFR<90 in young adults (e.g., for MACE, at eGFR 70-80, ages 18-30: 2.37 events per 1000 person-years(p-y), HR 1.31(1.27-1.40); ages 40-49: 6.26/1000p-y, HR 1.09(1.06-1.12); ages 50-65: 14.9/1000p-y, HR 1.07(1.05-1.08)). Elevations in relative risk occurred for 18-39-year-olds at higher eGFR levels than ages 40-49 and 50-65. This persisted when examining each component individually and in additional analyses (stratified by past CV disease, accounting for index albuminuria, defining index eGFR from repeated measures).

Conclusion

In young adults, eGFR levels above the current threshold for chronic kidney disease associated with an elevated risk for MACE and MACE+, warranting age-appropriate risk stratification, proactive monitoring, and timely intervention.