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Abstract: TH-PO228

Risk Factors for Progressive Cardiorenal Syndrome in CKD Patients

Session Information

Category: Hypertension and CVD

  • 1602 Hypertension and CVD: Clinical

Authors

  • Chen, Jing, Tulane University School of Medicine, New Orleans, Louisiana, United States
  • Hamm, L. Lee, Tulane University School of Medicine, New Orleans, Louisiana, United States
  • Jaar, Bernard G., Johns Hopkins University, Baltimore, Maryland, United States
  • He, Hua, Tulane University, New Orleans, Louisiana, United States
  • Zhao, Cong, Tulane University, New Orleans, Louisiana, United States
  • Geng, Siyi, Tulane University, New Orleans, Louisiana, United States
  • Anderson, Amanda Hyre, Tulane University, New Orleans, Louisiana, United States
  • Batuman, Vecihi, Tulane University School of Medicine, New Orleans, Louisiana, United States
  • Bundy, Joshua David, Tulane University, New Orleans, Louisiana, United States
  • Taliercio, Jonathan J., Cleveland Clinic, Cleveland, Ohio, United States
  • Rao, Panduranga S., University of Michigan Michigan Medicine, Ann Arbor, Michigan, United States
  • Schrauben, Sarah J., University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Djokic, Milica, Tulane University, New Orleans, Louisiana, United States
  • Merriman, Joel, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Rodriguez Mendez de Sosa, Giselle M., University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States
  • Go, Alan S., The Permanente Medical Group Inc, Oakland, California, United States
  • Lash, James P., University of Illinois Chicago, Chicago, Illinois, United States
  • He, Jiang, Tulane University, New Orleans, Louisiana, United States
Background

Cardiorenal syndrome (CRS) is linked with poor outcomes. We studied the incidence and risk factors for progressive CRS (pCRS) in CKD patients.

Methods

3,557 CKD patients in the Chronic Renal Insufficiency Cohort (CRIC) Study were included in this analysis after excluding those with heart failure (HF) at baseline. The mean follow-up was 10.5 years. pCRS was defined as development of both HF and renal failure (RF) (ESKD) within 12 months of each other. Cox proportional hazards models were used to examine the association of risk factors and pCRS. Risk factors for CRS type 2 (HF preceded RF) and CRS type 4 (RF preceded HF) were also analyzed.

Results

The average age was 59 years for those with pCRS and 57 years for those without. Age-adjusted incidence was 4.5/1000 person years, and was 5.0 in Men and 5.9 in Black. Traditional risk factors [multivariable-adjusted hazard ratios (95% CI)] for pCRS were less than high school education [1.82 (1.21, 2.73)], history of CVD [1.48 (1.03, 2.12)], lower eGFR [per 1SD,1.83 (1.40, 2.39)], and higher uACR [per 1SD, 2.26 (1.78, 2.86)]. The significant multivariable-adjusted HRs associated with novel risk factors are presented in Table. The risk factor associated with both CRS type 2 and 4 were kidney dysfunction, albuminuria, and mineral bone disorder (higher alkaline phosphatase and FGF23), inflammation (TNF-α ), and fibrotic factor (GDF-15).

Conclusion

This study indicates that education level, history of CVD, kidney dysfunction, albuminuria, mineral bone disorder, diabetes control, anemia, volume overload, inflammation, and fibrotic factor are associated with pCRS. Further studies are warranted to assess the benefits of specific interventions to improve CRS outcomes.

Multivariable-Adjusted Hazard Ratios of Progressive Cardiorenal Syndrome Associated with Novel Risk Factors
Variables (per SD)Multivariable-adjusted*  
 HR(95% CI)P-value
Hemoglobin (1.77 g/dL)0.82(0.68, 0.99)0.049
Hemoglobin A1C (1.53 %)1.31(1.14, 1.52)0.001
Log (alkaline phosphatase, 0.32 U/L)1.18(1.00, 1.38)0.045
Log (brain natriuretic peptide, 1.25 pg/mL)1.32(1.10, 1.57)0.002

*Adjusted for age, sex, race, clinic sites, and significant traditional risk factors

Funding

  • NIDDK Support