Cardiovascular risk is similar in patients with glomerulonephritis compared to other types of chronic kidney disease: a matched cohort study.
BACKGROUND
Patients with chronic kidney disease (CKD) due to glomerulonephritis (GN) are thought to be at high risk for cardiovascular disease (CVD). However, no study has examined whether GN directly contributes to CV risk beyond the effects conferred by pre-existing traditional risk factors and level of renal function.


METHODS
Matched cohort study using the previously described prospective CanPREDDICT study cohort. 2187 patients with CKD (eGFR 15-45 ml/min/m2) from 25 Canadian centres were divided into GN vs non-GN cause of CKD. Patients on immunotherapy for GN were not included in the study. Standardized measures of CV risk factors, biomarkers and CV outcomes were recorded over 3 years of follow-up, with the primary outcome measure being time to first all-cause CV event.


RESULTS
In the overall cohort, CV events occurred in 25 (8.7%) of the GN group and 338 (17.8%) of the non-GN group (HR 0.45, 95% CI 0.30-0.67, p < 0.01). In a Cox regression multivariable model that included age, sex, prior diabetes and CVD, baseline eGFR and onset of renal replacement therapy, the risk of CV events was similar in the GN and non-GN groups (HR 0.71, 95% CI 0.47-1.08, p = 0.11). GN and non-GN patients were matched by age and using a propensity score including sex, prior diabetes and CVD and baseline eGFR. In the matched group, the risk of CV events was similar in GN vs non-GN patients (N = 25/271 (9.2%) in both groups, HR 1.01, 95% CI 0.05-1.77, p = 0.9). An interaction analysis showed that CRP, ACR and troponin conferred differing amounts of CV risk in the GN and non-GN groups.


CONCLUSIONS
Patients with advanced CKD due to GN have a high 8.7% absolute 3-year risk of CVD, attributable to prior CV risk factors and level of kidney function rather than the GN disease itself.
['Hutton|Holly L|HL|', 'Levin|Adeera|A|', 'Gill|Jagbir|J|', 'Djurdjev|Ognjenka|O|', 'Tang|Mila|M|', 'Barbour|Sean J|SJ|']
D017677:Age Distribution D002170:Canada D002318:Cardiovascular Diseases D015984:Causality D015331:Cohort Studies D015897:Comorbidity D005260:Female D005921:Glomerulonephritis D006801:Humans D008137:Longitudinal Studies D008297:Male D008875:Middle Aged D015995:Prevalence D051436:Renal Insufficiency, Chronic D018570:Risk Assessment D017678:Sex Distribution D015996:Survival Rate
Glomerulonephritis Chronic kidney disease Cardiovascular disease