Cardiovascular Disease in Patients with CKD – 2018
(Gleaned from the 2018 USRDS Annual Data Report: Volume 1, Chapter 4: www.usrds.org)
Cardiovascular disease (CVD) remains the leading cause of death in the United States and most other developed countries. It accounts for approximately 39 percent of deaths among those on dialysis. Among patients with chronic kidney disease (CKD), death from CVD is far more common than progression to end-stage renal disease (ESRD). CKD has been identified as an independent risk factor for CVD, and arguably should be recognized as a coronary disease risk equivalent, similar to diabetes mellitus (DM). The complex relationship between CVD and kidney disease is thought to be due to shared traditional risk factors, such as DM, hypertension (HTN), physical inactivity, left ventricular hypertrophy, smoking, family history and abnormal lipid levels in the blood.
- CVD prevalence was 64.5% among patients aged 66 and older who had CKD, compared to 32.4% among those who did not have CKD.
- CKD is associated with worsened short- and long-term prognosis for many common cardiovascular diseases. The adjusted two-year survival of patients with acute myocardial infarction (AMI) and without a diagnosis of CKD was 82%, compared with 75% for CKD Stage 1-2 patients and 59% for Stage 4-5 patients.
- Cardiovascular disease is also associated with worsened short- and long-term prognosis for patients with CKD. Over a two-year period, Medicare patients with both heart failure and CKD had an adjusted survival probability of 77.8%, compared to 90.2% for those with CKD alone.
- Atrial fibrillation (AF) among CKD patients is high, presenting in approximately one-quarter of the population. AF prevalence was higher among males, older persons, and patients with hypertension (HTN), advanced stages of CKD, and heart failure (HF). Nearly half of CKD patients with heart failure had a diagnosis of AF.
- Angiotensin-converting enzyme inhibitors (ACEs) and angiotensin receptor blockers (ARBs) are mainstays of heart failure therapy and were prescribed to 59.9% of CKD patients with heart failure, compared to 61.2% of non-CKD patients with heart failure. Although direct oral anticoagulants have been less studied among patients with CKD, these drugs were prescribed to 30.9% of patients with AF and CKD, as compared with 33.2% of patients with AF and no CKD.