Abstract: FR-PO370
AKI as a Key Predictor of Cardiovascular Events in Patients with CKD: The CKD-REIN Study
Session Information
- Hypertension, CVD, and the Kidneys: Epidemiology
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1602 Hypertension and CVD: Clinical
Authors
- Hamroun, Aghiles, Centre Hospitalier Universitaire de Lille, Lille, Hauts-de-France, France
- Aymes, Estelle, Centre Hospitalier Universitaire de Lille, Lille, Hauts-de-France, France
- Frimat, Luc, Centre Hospitalier Regional Universitaire de Nancy, Nancy, Grand Est, France
- Laville, Maurice, Universite de Lyon, Lyon, Auvergne-Rhône-Alpes , France
- Lange, Celine, Agence de la biomedecine, La Plaine Saint-Denis, France
- Liabeuf, Sophie, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, Hauts-de-France, France
- Massy, Ziad, AURA Paris, Paris, Île-de-France, France
- Stengel, Benedicte, Centre de Recherche en Epidemiologie et Sante des Populations, Villejuif, Île-de-France, France
- Alencar de Pinho, Natalia, Centre de Recherche en Epidemiologie et Sante des Populations, Villejuif, Île-de-France, France
- Florens, Nans, Les Hopitaux Universitaires de Strasbourg, Strasbourg, Grand Est, France
Background
Chronic kidney disease (CKD) is a well-established risk factor for cardiovascular events, but less is known about the specific contribution of acute-on-chronic kidney disease events. This study aims to analyze the relationship between incident acute kidney injury (AKI) episodes and subsequent Major Adverse Cardiovascular Events (MACE) in a population of CKD patients.
Methods
From 2013 to 2016, the CKD-REIN prospective cohort enrolled 3033 adults with CKD stages 2-5 from 40 outpatient nephrology clinics in France. During a 5-year follow-up, all AKI episodes were validated by an expert committee according to the KDIGO-AKI definition. Cardiovascular events were classified using clinical trial Cardiovascular and Stroke Endpoint Definitions and cardiovascular deaths adjudicated by expert. The association of incident AKI with subsequent MACE risk was analyzed using a multivariable Cox model, treating AKI as a time-dependent variable and stratifyied by AKI characteristics.
Results
Overall, 530 patients experienced at least one incident AKI episode during follow-up. After adjustment for multiple confounders, we observed a substantial increased hazard of MACE associated with AKI (HR = 5.78 [4.46; 7.49], p < 0.001), and this association remained significant for each MACE component. A dose-response relationship was observed, with higher risks in more severe AKI cases and among hospitalized versus non-hospitalized patients (Figure 1). This association was also confirmed across all subgroups, without any interaction with age, sex, CKD stage, nor major comorbidities (diabetes, history of AKI, or cardiovascular events), as well as in the sensitivity analyses.
Conclusion
Our study highlights a strong dose-response relationship between incident AKI and the risk of subsequent MACE in CKD patients. Our findings align with existing pathophysiological evidence, reinforcing the potential causal link between AKI and subsequent cardiovascular remodeling.