Diabetes 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%).
The current study evaluated whether chronic kidney disease is also a comparable coronary heart disease risk factor. Glomerular filtration rate (eGFR) and proteinuria were measured using hospital 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.
AdvertisementStudy population, 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.
The 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.
Over 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 person-years).
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. 12·4 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%).
The 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.
Reference: 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