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Studies Strengthen Kidney and Heart Disease Link
Studies Strengthen Kidney and Heart Disease Link -- Posted by Gumbo on 10-23-04 05:51
Studies Strengthen Kidney and Heart Disease Link
A pair of new epidemiology studies confirms that chronic kidney disease
independently increases the risk of developing cardiovascular disease, even
among people with early kidney disease and after considering other risk
factors such as diabetes, hypertension and high cholesterol.
The studies appeared in the New England Journal of Medicine.
One of the studies, "Chronic kidney disease (ckd) and the risk of death,
cardiovascular events, and hospitalization," was supported by the National
Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) at the U.S.
National Institutes of Health.
These studies "reinforce the importance of early detection of CKD, not only
to slow progression to [kidney failure] but also in this case to identify
risk factors for cardiovascular disease," said Thomas H. Hostetter, MD, in
an editorial accompanying the papers. Hostetter is a kidney specialist and
director of the National Kidney Disease Education Program at NIDDK.
The NIDDK-funded study followed more than 1.1 million adults from the Kaiser
Permanente Renal Registry in San Francisco for nearly 3 years; average age
was 52 years. Led by Alan S. Go, MD, the investigators found that when
kidney function (GFR) dropped, the risk of death, cardiovascular events such
as heart disease and stroke, and hospitalization increased. Compared to
patients whose GFR was at least 60 (ml per minute per 1.73 m72):
1) The increased risk of death ranged from 17% in those whose GFR was
between 45 and 59 to about 600% in those whose GFR was less than 15.
2) The increased risk of CVD events ranged from 43% in those whose GFR was
between 45 and 59 to 343% in those whose GFR was less than 15.
3) The increased risk of hospitalization ranged from 14% in those whose GFR
was between 45 and 59 to 315% in those whose GFR was less than 15.
The industry-funded VALIANT study related CKD to deaths from CVD in a 2-year
drug-treatment trial of more than 14,500 heart attack patients. The
researchers found death rates ranging from 14.1% in patients whose GFR was
at least 75 to 45.5% in those whose GFR was less than 45. The investigators
attribute the increased risk of death from CVD in part to complications of
kidney disease, including anemia, oxidative stress, changes in calcium and
phosphate regulation, inflammation, and conditions promoting clotting.
The researchers also suggested that other kidney-related factors such as
protein in the urine and elevated blood levels of both homocysteine and uric
acid may increase the risk of CVD and death. Furthermore, they found that
common CVD therapies such as aspirin and beta-blockers were "curiously under
used" in CKD patients with lower kidney function, perhaps inspired by a
fatalist mind-set that may be a self-fulfilling prophecy.
An ongoing study supported by NIDDK will help further explain the connection
between CKD and CVD and should lead to improved management of these
diseases. Investigators in the Chronic Renal Insufficiency Cohort study are
looking at earlier kidney disease than most trials have previously studied
and are conducting the most thorough review to date of the relative impact
of known risk factors for kidney and heart diseases.
NKDEP and its partners recommend regular creatinine testing and the MDRD
equation to estimate GFR in adults at high risk for kidney disease - those
with diabetes, high blood pressure or a family history of kidney problems,
especially African Americans, Hispanic Americans and Native Americans.
Both the Kaiser and VALIANT studies used the MDRD equation to estimate GFR.
The formula considers age, sex, race and the blood level of a substance
called creatinine. Creatinine alone is commonly used to test for kidney
disease, but up to two thirds of kidney function may be lost before the test
raises suspicions. The MDRD equation was developed in an NIDDK-supported
clinical trial completed in the early 1990s and is widely considered the
best-validated method for assessing kidney function. However, most labs and
doctors still aren't using it.
This is unfortunate, since a simple web-based calculator based on the MDRD
equation can compute GFR, and since creatinine is often measured in standard
lab tests, according to Hostetter's editorial. NKDEP is encouraging doctors
and labs to use creatinine and the MDRD equation so that patients can be
diagnosed and treated earlier. The calculator may also be used on hand-held
devices (Chronic kidney disease and the risk of death, cardiovascular
events, and hospitalization, N Engl J Med, 2004;351:1296-305;
http://content.nejm.org/cgi/content/short/351/13/1296; Relation between
renal dysfunction and cardiovascular outcomes after myocardial infarction. N
Engl J Med, 2004;351:1285-95;
http://content.nejm.org/cgi/content/abstract/351/13/1285; Chronic kidney
disease predicts cardiovascular disease. N Engl J Med 2004;351:1344-6;
http://content.nejm.org/cgi/content/full/351/13/1344-a).
This article was prepared by Biotech Law Weekly editors from staff and other
reports
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