Risk of Coronary Events in Chronic Kidney Disease Patients as Compared With Diabetes Patients

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.

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Study 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).

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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).

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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.

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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

Source-Medindia