对患有各种原发性肾小球疾病的患者的心血管疾病(CVD)的风险知之甚少。在患有原发性肾小球疾病的成年人的人群水平队列中,我们试图描述与普通人群相比的CVD风险,以及传统和肾脏相关风险因素对CVD风险的影响.
观察性队列研究。
成人膜性肾病(n=387),微小变化疾病(n=226),IgA肾病(n=759),和局灶性节段性肾小球硬化(n=540),来自不列颠哥伦比亚省的集中病理登记处,加拿大(2000-2012年)。
传统CVD危险因素(糖尿病,年龄,性别,血脂异常,高血压,吸烟,既往CVD)和肾脏相关危险因素(肾小球疾病类型,估计的肾小球滤过率[eGFR],蛋白尿)。
冠状动脉的复合CVD结果,脑血管,和外周血管事件,和因心肌梗塞或中风而死亡。
亚分布风险模型评估非CVD死亡作为竞争事件的结局风险.基于年龄和性别匹配的一般人群计算的标准化发病率(SIR)。
在平均6.8年的随访中,212名患者(11.1%)经历了CVD结局(10年风险,14.7%[95%CI,12.8%-16.8%])。总体队列(24.7/1000人年)和每种疾病类型(范围,每1000人年12.2-46.1),并且在总体上都高于一般人群中观察到的水平(SIR,2.46[95%CI,2.12-2.82]),对于每种疾病类型(SIR范围,1.38-3.98)。疾病类型,基线eGFR,和蛋白尿与CVD的高风险相关,当添加到具有传统风险因素的模型中时,导致模型拟合度的提高(R2为14.3%对12.7%),风险歧视(0.81对0.78的C统计量;差异,0.02[95%CI,0.01-0.04]),和持续的净重新分类改善(0.4[95%CI,0.2-0.6])。
使用管理数据确定结果和合并症。
原发性肾小球疾病患者的CVD绝对风险较高,约为普通人群的2.5倍。考虑eGFR,蛋白尿,肾小球疾病的类型可能会改善这些个体的CVD风险分层。
已知患有慢性肾脏疾病的患者具有心血管疾病的高风险。原发性肾小球疾病患者的心血管风险知之甚少,因为这些疾病很少见,需要肾脏活检才能诊断。在这项对1,912名加拿大活检证实的IgA肾病患者的研究中,微小变化疾病,局灶性节段肾小球硬化,膜性肾病,心血管事件的发生率是普通人群的2.5倍,并且每种疾病类型的发生率都很高.考虑疾病类型,肾功能,蛋白尿改善了心血管事件的预测。总之,我们的人群水平研究表明,原发性肾小球疾病患者有很高的心血管风险,纳入肾脏特异性危险因素可能会改善风险分层。
Little is known about the risk of cardiovascular disease (CVD) in patients with various primary glomerular diseases. In a population-level cohort of adults with primary glomerular disease, we sought to describe the risk of CVD compared with the general population and the impact of traditional and kidney-related risk factors on CVD risk.
Observational cohort study.
Adults with membranous nephropathy (n = 387), minimal change disease (n = 226), IgA nephropathy (n = 759), and focal segmental glomerulosclerosis (n = 540) from a centralized pathology registry in British Columbia, Canada (2000-2012).
Traditional CVD risk factors (diabetes, age, sex, dyslipidemia, hypertension, smoking, prior CVD) and kidney-related risk factors (type of glomerular disease, estimated glomerular filtration rate [eGFR], proteinuria).
A composite CVD outcome of coronary artery, cerebrovascular, and peripheral vascular events, and death due to myocardial infarction or stroke.
Subdistribution hazards models to evaluate the outcome risk with non-CVD death treated as a competing event. Standardized incidence rates (SIR) calculated based on the age- and sex-matched general population.
During a median 6.8 years of follow-up, 212 patients (11.1%) experienced the CVD outcome (10-year risk, 14.7% [95% CI, 12.8%-16.8%]). The incidence rate was high for the overall cohort (24.7 per 1,000 person-years) and for each disease type (range, 12.2-46.1 per 1,000 person-years), and was higher than that observed in the general population both overall (SIR, 2.46 [95% CI, 2.12-2.82]) and for each disease type (SIR range, 1.38-3.98). Disease type, baseline eGFR, and proteinuria were associated with a higher risk of CVD and, when added to a model with traditional risk factors, led to improvements in model fit (R2 of 14.3% vs 12.7%), risk discrimination (C-statistic of 0.81 vs 0.78; difference, 0.02 [95% CI, 0.01-0.04]), and continuous net reclassification improvement (0.4 [95% CI, 0.2-0.6]).
Ascertainment of outcomes and comorbidities using administrative data.
Patients with primary glomerular disease have a high absolute risk of CVD that is approximately 2.5 times that of the general population. Consideration of eGFR, proteinuria, and type of glomerular disease may improve risk stratification of CVD risk in these individuals.
Patients with chronic kidney disease are known to be at high risk of cardiovascular disease. Cardiovascular risk in patients with primary glomerular diseases is poorly understood because these conditions are rare and require a kidney biopsy for diagnosis. In this study of 1,912 Canadian patients with biopsy-proven IgA nephropathy, minimal change disease, focal segmental glomerulosclerosis, and membranous nephropathy, the rate of cardiovascular events was 2.5 times higher than in the general population and was high for each disease type. Consideration of disease type, kidney function, and proteinuria improved the prediction of cardiovascular events. In summary, our population-level study showed that patients with primary glomerular diseases have a high cardiovascular risk, and that inclusion of kidney-specific risk factors may improve risk stratification.