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Cited by 275Chronic Kidney Disease and DiabetesDialysis and Renal Disease ManagementBlood Pressure and Hypertension Studies

Chronic kidney disease and risk of major cardiovascular disease and non-vascular mortality: prospective population based cohort study

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Di Angelantonio, E., Chowdhury, R., Sarwar, N., Aspelund, T., Danesh, J., Gudnason, V.·2010·BMJ
DOI 10.1136/bmj.c4986PMC PMC2948649
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Abstract

OBJECTIVE: To quantify associations of chronic kidney disease stages with major cardiovascular disease and non-vascular mortality in the general adult population. DESIGN: Prospective population based cohort study. SETTING: Reykjavik, Iceland. PARTICIPANTS: 16 958 people aged 33-81 years without manifest vascular disease and with available information on stage of chronic kidney disease (defined by both estimated glomerular filtration rate and urinary protein) at study entry. MAIN OUTCOME MEASURES: Hazard ratios for time to major coronary heart disease outcomes and mortality. RESULTS: 1210 (7%) of participants had chronic kidney disease at entry. During a median follow-up of 24 years, 4010 coronary heart disease outcomes, 559 deaths from stroke, and 3875 deaths from non-vascular causes were recorded. Compared with the reference group (estimated glomerular filtration rate 75-89 ml/min/1.73 m(2) and no proteinuria), people with lower renal function within the normal range of glomerular filtration rate did not have significantly higher risk of coronary heart disease. By contrast, in 1210 (7%) participants with chronic kidney disease at entry, hazard ratios for coronary heart disease, adjusted for several conventional cardiovascular risk factors, were 1.55 (95% confidence interval 1.02 to 2.35) for stage 1, 1.72 (1.30 to 2.24) for stage 2, 1.39 (1.22 to 1.58) for stage 3a, 1.90 (1.22 to 2.96) for stage 3b, and 4.29 (1.78 to 10.32) for stage 4. Information on chronic kidney disease increased discrimination and reclassification indices for coronary heart disease when added to conventional risk factors (P<0.01). The incremental gain provided by chronic kidney disease was lower than that provided by diabetes or smoking (C index increases of 0.0015, 0.0024, and 0.0124 respectively). Hazard ratios with chronic kidney disease were 0.97 (0.82 to 1.15) for cancer mortality and 1.26 (1.07 to 1.50) for other non-vascular mortality. CONCLUSIONS: In people without manifest vascular disease, even the earliest stages of chronic kidney disease are associated with excess risk of subsequent coronary heart disease. Assessment of chronic kidney disease in addition to conventional risk factors modestly improves prediction of risk for coronary heart disease in this population. Further studies are needed to investigate associations between chronic kidney disease and non-vascular mortality from causes other than cancer.

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  • CKD stage is gradedly associated with cardiovascular risk.

    “The graded association between CKD stage and cardiovascular risk highlights the urgent need to identify beneficial therapies for this population (41).”

    From Effects of Fibrates in Kidney Disease (2012) · cites this paper as [41]

    The Results (page not available in our copy) report higher coronary heart disease risk at every CKD stage than in the reference group, supporting an association between CKD stage and cardiovascular risk. But the paper calls the relation non-linear, and the reported risk for stage 3a is lower than for stage 2, so it does not establish a consistently graded increase across stages. The need for therapies is the citing authors’ conclusion, not a finding attributed to this source. (LLM, conf=0.88)

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Research works printed but not linked: 28

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Authors
Di Angelantonio, E., Chowdhury, R., Sarwar, N., Aspelund, T., Danesh, J., & Gudnason, V.
Affiliations
  • University of Cambridge (GB)
  • University of Aberdeen (GB)
  • University of Iceland (IS)
ORCID
Venue
BMJ
Publisher
BMJ
Published
2010-09-30
Volume
341
Issue
sep30 1
Pages
c4986-c4986
ISSN
  • 0007-1447 (ISSN-L)
  • 0959-8138
  • 1468-5833
DOI
10.1136/bmj.c4986
PMC
PMC2948649
OpenAlex
W2093469848
Cited by
275
References
3
Citations by year
2026: 8 · 2025: 7 · 2024: 7 · 2023: 9 · 2022: 10 · 2021: 14 · 2020: 20 · 2019: 20 · 2018: 18 · 2017: 11 · 2016: 22 · 2015: 17 · 2014: 33 · 2013: 27 · 2012: 31
FWCI
19.54
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
Funders
British Heart Foundation (RG/08/014/24067)
Topics
  • Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
  • Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
Keywords
cardiovascular disease, coronary artery disease, stroke mortality, estimated glomerular filtration rate, proteinuria, cardiovascular risk reclassification, cancer mortality, renal function
MeSH terms
Adult, Aged, Aged, 80 and over, Cardiovascular Diseases, Female, Humans, Iceland, Kidney Failure, Chronic, Male, Middle Aged, Prognosis, Prospective Studies, Risk Factors, Socioeconomic Factors

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