Kidney Markers May Help Predict Cardiovascular Outcomes

Key measures of chronic kidney disease (CKD) can improve prediction of cardiovascular outcomes, suggests a meta-analysis in Lancet Diabetes and Endocrinology.

The analysis included individual-level data on more than 637,000 individuals with no history of cardiovascular disease, drawn from 24 cohorts included in the Chronic Kidney Disease Prognosis Consortium. The median follow-up times ranged from 4 to 19 years. The study focused on the cardiovascular predictive value achieved by adding creatinine-based estimated GFR (eGFR), albuminuria, or both to traditional risk factors. Albuminuria was assessed by either albumin-to-creatinine ratio (ACR) or dipstick proteinuria. The 5-year outcomes of interest were cardiovascular mortality and fatal or nonfatal coronary heart disease, stroke, and heart failure.

In general populations, adding eGFR and ACR to traditional risk factors significantly improved discrimination. The greatest improvements were seen for cardiovascular mortality, with C statistic differences of 0.0139 for ACR and 0.0065 for eGFR; and heart failure, with differences of 0.0196 and 0.0109, respectively. Dipstick proteinuria had less predictive value than did ACR.

Adding eGFR and ACR to predictive models offered the best discrimination improvement in patients with diabetes or hypertension. However, ACR still had significant predictive value for cardiovascular death or heart failure in patients with neither of those conditions. For patients with CKD, the combination of eGFR and ACR had better risk discrimination than did traditional risk factors.

There are conflicting data as to whether key measures of kidney health are relevant to cardiovascular risk prediction. This meta-analysis suggests that eGFR and ACR have significant cardiovascular predictive value and should be considered when these measures are already available or if there is special interest in assessing the risk of cardiovascular death or heart failure [Matsushita K, et al. Estimated glomerular filtration rate and albuminuria for prediction of cardiovascular outcomes: a collaborative meta-analysis of individual participant data. Lancet Diabetes Endocrinol 2015; doi:10.1016/S2213-8587(1500040-6]).