Major cardiovascular events and subsequent risk of kidney failure with replacement therapy: a CKD Prognosis Consortium study

Mark PB, Carrero JJ, Matsushita K, Sang Y, Ballew SH, Grams ME, Coresh J, Surapaneni A, Brunskill NJ, Chalmers J, Chan L, Chang AR, Chinnadurai R, Chodick G, Cirillo M, De Zeeuw D, Evans M, Garg AX, Gutierrez OM, Heerspink HJL, Heine GH, Herrington WG, Ishigami J, Kronenberg F, Lee JY, Levin A, Major RW, Marks A, Nadkarni GN, Naimark DMJ, Nowak C, Rahman M, Sabanayagam C, Sarnak M, Sawhney S, Schneider M, Shalev V, Shin JI, Siddiqui MK, Stempniewicz N, Sumida K, Valdivielso JM, Van Den Brand J, Wang AYM, Wheeler DC, Zhang L, Visseren FLJ, Stengel B (2023)

Publication Type: Journal article

Publication year: 2023


DOI: 10.1093/eurheartj/ehac825


Aims Chronic kidney disease (CKD) increases risk of cardiovascular disease (CVD). Less is known about how CVD associates with future risk of kidney failure with replacement therapy (KFRT). Methods and results The study included 25 903 761 individuals from the CKD Prognosis Consortium with known baseline estimated glomerular filtration rate (eGFR) and evaluated the impact of prevalent and incident coronary heart disease (CHD), stroke, heart failure (HF), and atrial fibrillation (AF) events as time-varying exposures on KFRT outcomes. Mean age was 53 (standard deviation 17) years and mean eGFR was 89 mL/min/1.73 m(2), 15% had diabetes and 8.4% had urinary albumin-to-creatinine ratio (ACR) available (median 13 mg/g); 9.5% had prevalent CHD, 3.2% prior stroke, 3.3% HF, and 4.4% prior AF. During follow-up, there were 269 142 CHD, 311 021 stroke, 712 556 HF, and 605 596 AF incident events and 101 044 (0.4%) patients experienced KFRT. Both prevalent and incident CVD were associated with subsequent KFRT with adjusted hazard ratios (HRs) of 3.1 [95% confidence interval (CI): 2.9-3.3], 2.0 (1.9-2.1), 4.5 (4.2-4.9), 2.8 (2.7-3.1) after incident CHD, stroke, HF and AF, respectively. HRs were highest in first 3 months post-CVD incidence declining to baseline after 3 years. Incident HF hospitalizations showed the strongest association with KFRT [HR 46 (95% CI: 43-50) within 3 months] after adjustment for other CVD subtype incidence. Conclusion Incident CVD events strongly and independently associate with future KFRT risk, most notably after HF, then CHD, stroke, and AF. Optimal strategies for addressing the dramatic risk of KFRT following CVD events are needed.

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Involved external institutions

Johns Hopkins University (JHU) US United States (USA) (US) Tufts University US United States (USA) (US) Karolinska Institute SE Sweden (SE) University of Aberdeen GB United Kingdom (GB) Università degli Studi di Salerno IT Italy (IT) University of British Columbia CA Canada (CA) Northern Care Alliance NHS Trust GB United Kingdom (GB) University of Hong Kong (HKU) / 香港大學 HK Hong Kong (HK) Medizinische Universität Innsbruck AT Austria (AT) University of New South Wales (UNSW) AU Australia (AU) University of Leicester GB United Kingdom (GB) Institut de Recerca Biomèdica de Lleida (IRBLleida) ES Spain (ES) Geisinger Health System US United States (USA) (US) University of Paris 11 - Paris-Sud / Université Paris XI Paris-Sud FR France (FR) Nanjing University CN China (CN) University of Glasgow GB United Kingdom (GB) University of Dundee GB United Kingdom (GB) Case Western Reserve University US United States (USA) (US) Icahn School of Medicine at Mount Sinai US United States (USA) (US) Singapore Eye Research Institute SG Singapore (SG) University of Alabama at Birmingham (UAB) US United States (USA) (US) Institute for Clinical Evaluative Sciences (ICES) CA Canada (CA) University Medical Centre Utrecht (UMC Utrecht) NL Netherlands (NL) University of Groningen / Rijksuniversiteit Groningen NL Netherlands (NL) Tel Aviv University IL Israel (IL) Yonsei University KR Korea, Republic of (KR) Radboud University Nijmegen NL Netherlands (NL) Karolinska University Hospital / Karolinska Universitetssjukhuset SE Sweden (SE) American Medical Group Association (AMGA) US United States (USA) (US) Universität des Saarlandes (UdS) DE Germany (DE) University of Tennessee (UTK) US United States (USA) (US) University of Oxford GB United Kingdom (GB) University of Toronto CA Canada (CA)

How to cite


Mark, P.B., Carrero, J.J., Matsushita, K., Sang, Y., Ballew, S.H., Grams, M.E.,... Stengel, B. (2023). Major cardiovascular events and subsequent risk of kidney failure with replacement therapy: a CKD Prognosis Consortium study. European Heart Journal.


Mark, Patrick B., et al. "Major cardiovascular events and subsequent risk of kidney failure with replacement therapy: a CKD Prognosis Consortium study." European Heart Journal (2023).

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