is considered to be a risk factor for coronary heart disease equivalent or
similar to myocardial infarction (MI). Coronary
heart disease risk equivalent is the degree of 10-year risk of developing
coronary death or myocardial infarction that is equal to the risk linked to
previous myocardial infarction (>20%).
current study evaluated whether chronic kidney disease is also a comparable
coronary heart disease risk factor. Glomerular
filtration rate (eGFR) and proteinuria were measured
admission and medical-claim data in order to assess the risk of hospital
admission for MI in previous MI, diabetes mellitus, or chronic kidney disease
patients compared with people without these disorders.
of1·3 million people, included adults
aged ≥18 years without end-stage renal disease, with a serum creatinine
measurement in 2002-2009 and an eGFR ≥15 mL/min/ 1·73 m2.
The patients either had chronic kidney disease without diabetes or diabetes
without chronic kidney disease. A patient was defined as having chronic
kidney disease when the eGFR was ≥60 mL/min/1·73 m2.
first hospital admission for myocardial
infarction was the primary outcome
while all-cause mortality was the secondary outcome
. A subgroup of
patients hospitalized for MI were evaluated for short-term (30 days) and
long-term (end of study) mortality.
an average follow-up of 48 months, 1% of the study population was hospitalized
for MI. Of these, highest incidence of
MI hospitalization occurred in previous MI patients
(18·5 per 1000
Patients without prior MI had a lower rate
of MI in diabetes patients without chronic kidney disease
(5·4 per 1000
person-years) as compared to chronic kidney disease patients without diabetes (6·9
per 1000 person-years). MI incidence was considerably greater in chronic kidney
disease patients than in diabetes patients (8.0 per 1000 person-years vs. 5.4
per 1000 person-years).
Incidence of MI in diabetes patients was
significantly lower than for those with chronic kidney disease
as shown by
eGFR of <45 mL/min/1·73 m2 and highly increased proteinuria (6·6
per 1000 person-years vs.
per 1000 person-years).
Patients who died within 30 days of MI
hospitalization was markedly greater in chronic kidney disease patients without
diabetes or previous MI (14%)
as compared with diabetes patients without
chronic kidney disease or previous MI (8%) or patients with prior MI (10%).
study concludes that chronic kidney disease can be included in the list of
conditions that places a person at the maximum risk of future coronary events.
Risk of coronary events in people with chronic kidney disease compared with
those with diabetes: a population-level cohort study; Marcello Tonelli; The
Lancet Online Publication 2012