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Cardiovascular and renal outcome in subjects with K/DOQI stage 1-3 chronic kidney disease: the importance of urinary albumin excretion.
Nephrol Dial Transplant. 2008 Dec; 23(12):3851-8.ND

Abstract

BACKGROUND

The Kidney Disease Outcomes Quality Initiative guidelines aim to define chronic kidney disease (CKD) and classify its stages. Stage 3 CKD generally receives more attention than stage 1 or 2, because the more impaired glomerular filtration rate (GFR) in stage 3 suggests a higher cardiovascular and renal risk. In this study we evaluated cardiovascular and renal outcome in subjects with stage 1 and 2 CKD. For comparison, we also studied these outcomes in stage 3 CKD.

METHODS

We used data of 8495 subjects of the PREVEND study, a prospective community-based cohort study, with data on urinary albumin excretion (UAE) and serum creatinine available. As measure of cardiovascular outcome, combined cardiovascular morbidity and mortality was used. As renal outcome, mean annual change of estimated GFR (eGFR) was used.

RESULTS

6905 subjects had no CKD; 243, 856 and 491 subjects had stage 1, 2 and 3 CKD, respectively. During a median follow-up of 7.5 years 565 cardiovascular events occurred. Incidence rates of cardiovascular events were higher (P < 0.001 for all groups) in subjects with stage 1-3 CKD (17.2, 22.2 and 20.9 events/1000 person-years, respectively) than in subjects without CKD (7.0 events/1000 person-years). Using subjects without CKD as reference, age- and sex-adjusted hazard ratios [HR (95% CI)] were 2.2 (1.5-3.3), 1.6 (1.3-2.0) and 1.3 (1.0-1.7), respectively. Compared to subjects without CKD but similar baseline eGFR, subjects with stage 1 or 2 CKD showed a larger decline in eGFR (-1.1 versus -1.5 and -0.2 versus -0.6 ml/min/1.73 m(2)/year, respectively, both P < 0.01). When subjects with stage 3 CKD were stratified according to the absence or presence of a UAE >30 mg/24 h, age- and sex-adjusted HRs for CVD were 1.0 (0.7-1.4) and 1.6 (1.1-2.3) and the change in eGFR was 0.2 versus -0.3 ml/min/1.73 m(2)/year, respectively.

CONCLUSION

Subjects with stage 1 or 2 CKD have an increased risk for adverse cardiovascular and renal outcome and should receive equal attention as subjects with stage 3 CKD. Subdividing stage 3 CKD according to the presence or absence of a UAE >30 mg/24 h improves risk stratification within this stage.

Authors+Show Affiliations

Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18641082

Citation

Brantsma, Auke H., et al. "Cardiovascular and Renal Outcome in Subjects With K/DOQI Stage 1-3 Chronic Kidney Disease: the Importance of Urinary Albumin Excretion." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 23, no. 12, 2008, pp. 3851-8.
Brantsma AH, Bakker SJ, Hillege HL, et al. Cardiovascular and renal outcome in subjects with K/DOQI stage 1-3 chronic kidney disease: the importance of urinary albumin excretion. Nephrol Dial Transplant. 2008;23(12):3851-8.
Brantsma, A. H., Bakker, S. J., Hillege, H. L., de Zeeuw, D., de Jong, P. E., & Gansevoort, R. T. (2008). Cardiovascular and renal outcome in subjects with K/DOQI stage 1-3 chronic kidney disease: the importance of urinary albumin excretion. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 23(12), 3851-8. https://doi.org/10.1093/ndt/gfn356
Brantsma AH, et al. Cardiovascular and Renal Outcome in Subjects With K/DOQI Stage 1-3 Chronic Kidney Disease: the Importance of Urinary Albumin Excretion. Nephrol Dial Transplant. 2008;23(12):3851-8. PubMed PMID: 18641082.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cardiovascular and renal outcome in subjects with K/DOQI stage 1-3 chronic kidney disease: the importance of urinary albumin excretion. AU - Brantsma,Auke H, AU - Bakker,Stephan J L, AU - Hillege,Hans L, AU - de Zeeuw,Dick, AU - de Jong,Paul E, AU - Gansevoort,Ronald T, AU - ,, Y1 - 2008/07/18/ PY - 2008/7/22/pubmed PY - 2009/3/3/medline PY - 2008/7/22/entrez SP - 3851 EP - 8 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol Dial Transplant VL - 23 IS - 12 N2 - BACKGROUND: The Kidney Disease Outcomes Quality Initiative guidelines aim to define chronic kidney disease (CKD) and classify its stages. Stage 3 CKD generally receives more attention than stage 1 or 2, because the more impaired glomerular filtration rate (GFR) in stage 3 suggests a higher cardiovascular and renal risk. In this study we evaluated cardiovascular and renal outcome in subjects with stage 1 and 2 CKD. For comparison, we also studied these outcomes in stage 3 CKD. METHODS: We used data of 8495 subjects of the PREVEND study, a prospective community-based cohort study, with data on urinary albumin excretion (UAE) and serum creatinine available. As measure of cardiovascular outcome, combined cardiovascular morbidity and mortality was used. As renal outcome, mean annual change of estimated GFR (eGFR) was used. RESULTS: 6905 subjects had no CKD; 243, 856 and 491 subjects had stage 1, 2 and 3 CKD, respectively. During a median follow-up of 7.5 years 565 cardiovascular events occurred. Incidence rates of cardiovascular events were higher (P < 0.001 for all groups) in subjects with stage 1-3 CKD (17.2, 22.2 and 20.9 events/1000 person-years, respectively) than in subjects without CKD (7.0 events/1000 person-years). Using subjects without CKD as reference, age- and sex-adjusted hazard ratios [HR (95% CI)] were 2.2 (1.5-3.3), 1.6 (1.3-2.0) and 1.3 (1.0-1.7), respectively. Compared to subjects without CKD but similar baseline eGFR, subjects with stage 1 or 2 CKD showed a larger decline in eGFR (-1.1 versus -1.5 and -0.2 versus -0.6 ml/min/1.73 m(2)/year, respectively, both P < 0.01). When subjects with stage 3 CKD were stratified according to the absence or presence of a UAE >30 mg/24 h, age- and sex-adjusted HRs for CVD were 1.0 (0.7-1.4) and 1.6 (1.1-2.3) and the change in eGFR was 0.2 versus -0.3 ml/min/1.73 m(2)/year, respectively. CONCLUSION: Subjects with stage 1 or 2 CKD have an increased risk for adverse cardiovascular and renal outcome and should receive equal attention as subjects with stage 3 CKD. Subdividing stage 3 CKD according to the presence or absence of a UAE >30 mg/24 h improves risk stratification within this stage. SN - 1460-2385 UR - https://www.unboundmedicine.com/medline/citation/18641082/Cardiovascular_and_renal_outcome_in_subjects_with_K/DOQI_stage_1_3_chronic_kidney_disease:_the_importance_of_urinary_albumin_excretion_ DB - PRIME DP - Unbound Medicine ER -