A1 Refereed original research article in a scientific journal
Cardiovascular Determinants of Mortality in Advanced Chronic Kidney Disease
Authors: Roosa Lankinen, Markus Hakamaki, Kaj Metsärinne, Niina S. Koivuviita, Jussi P. Pärkkä, Tapio Hellman, Noora Kartiosuo, Olli T. Raitakari, Mikko J. Järvisalo
Publisher: KARGER
Publication year: 2020
Journal: American Journal of Nephrology
Journal name in source: AMERICAN JOURNAL OF NEPHROLOGY
Journal acronym: AM J NEPHROL
Volume: 51
Issue: 9
First page : 726
Last page: 735
Number of pages: 10
ISSN: 0250-8095
eISSN: 1421-9670
DOI: https://doi.org/10.1159/000509582
Abstract
Background:Patients with advanced chronic kidney disease (CKD stage 4-5) have an increased risk of death. To study the determinants of all-cause mortality, we recruited 210 consecutive CKD stage 4-5 patients not on dialysis to the prospective Chronic Arterial Disease, quality of life and mortality in chronic KIDney injury (CADKID) study.Methods:One hundred seventy-four patients underwent maximal bicycle ergometry stress testing and lateral lumbar radiography to study abdominal aortic calcification score and echocardiography. Carotid and femoral artery intima-media thickness and elasticity and brachial artery flow-mediated dilatation were measured in 156 patients.Results:The duration of follow-up was 42 +/- 17 months (range 134-2,217 days). The mean age was 61 +/- 14 years, and the estimated glomerular filtration rate was 12 (11-15) mL/min/1.73 m(2). Thirty-six (21%) patients died during follow-up (time to death 835 +/- 372 days). Seventy-five and 21 patients had diabetes and coronary artery disease, respectively, and all but one had hypertension. In the respective multivariate proportional hazards models adjusted for age, sex, and coronary artery disease, the significant determinants of mortality were troponin T, N-terminal pro-B-type natriuretic peptide, maximal ergometry performance, abdominal aortic calcification score,E/e ' ratio, and albumin.Conclusion:Stress ergometry performance, abdominal aortic calcification score,E/e ' of echocardiography, and plasma cardiac biomarkers and albumin predict mortality in advanced CKD.
Background:Patients with advanced chronic kidney disease (CKD stage 4-5) have an increased risk of death. To study the determinants of all-cause mortality, we recruited 210 consecutive CKD stage 4-5 patients not on dialysis to the prospective Chronic Arterial Disease, quality of life and mortality in chronic KIDney injury (CADKID) study.Methods:One hundred seventy-four patients underwent maximal bicycle ergometry stress testing and lateral lumbar radiography to study abdominal aortic calcification score and echocardiography. Carotid and femoral artery intima-media thickness and elasticity and brachial artery flow-mediated dilatation were measured in 156 patients.Results:The duration of follow-up was 42 +/- 17 months (range 134-2,217 days). The mean age was 61 +/- 14 years, and the estimated glomerular filtration rate was 12 (11-15) mL/min/1.73 m(2). Thirty-six (21%) patients died during follow-up (time to death 835 +/- 372 days). Seventy-five and 21 patients had diabetes and coronary artery disease, respectively, and all but one had hypertension. In the respective multivariate proportional hazards models adjusted for age, sex, and coronary artery disease, the significant determinants of mortality were troponin T, N-terminal pro-B-type natriuretic peptide, maximal ergometry performance, abdominal aortic calcification score,E/e ' ratio, and albumin.Conclusion:Stress ergometry performance, abdominal aortic calcification score,E/e ' of echocardiography, and plasma cardiac biomarkers and albumin predict mortality in advanced CKD.
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