CARDIOVASCULAR events (CVE) in advanced chronic kidney disease (CKD) were associated with age, diabetes, smoking, and previous cardiovascular events, while renal function and proteinuria showed no significant association in a prospective cohort of predialysis patients.
Cardiovascular Events in Advanced CKD
CVE remain highly prevalent among patients with CKD, with risk traditionally thought to increase as kidney function declines. However, uncertainty remains surrounding renal function and its influence on cardiovascular risk in advanced disease stages. A prospective observational study has now examined this relationship in patients with advanced CKD who had a glomerular filtration rate below 30 ml/min and had not yet started dialysis.
Between 2016–2022, researchers enrolled 389 predialysis patients and followed them for a median of 19 months (interquartile range: 9–45 months). During follow up, 118 patients experienced a CVE, representing 30% of the study population. Of these events, 18 were fatal. The cohort had a mean age of 65±12.5 years and included 65% men. Additionally, 70% had a body mass index above 25 kg/m², 58% had diabetes, 53% were current or former smokers, and 30% had a history of previous CVEs.
Risk Factors Associated with CVEs
The investigators assessed measured glomerular filtration rate using plasma-clearance of iohexol and estimated glomerular filtration rate using four established equations. Associations between CVEs and renal function were analysed using logistic regression models adjusted for both traditional cardiovascular risk factors and CKD specific factors.
Several established cardiovascular risk factors were associated with new CVEs. Increasing age was linked to a higher risk (OR=1.06), while diabetes was associated with more than double the likelihood of an event (OR=2.53). Smoking also increased risk (OR=1.7), and a history of previous CVEs was strongly associated with future events (OR=2.89).
Renal Function Shows No Independent Association
Despite the cohort having advanced CKD, neither measured nor estimated renal function demonstrated an association with CVEs. Similarly, proteinuria, traditional cardiovascular risk factors beyond those identified, and CKD related factors were not associated with CVE occurrence.
The authors suggested that the absence of an association between renal function and cardiovascular outcomes may reflect the impact of strict guideline based pharmacological management across the cohort.
Conclusion
These findings indicate that, in predialysis patients with advanced CKD, traditional cardiovascular risk factors remain the primary determinants of CVEs, even when renal impairment is severe.
Reference
Escamilla-Cabrera B et al. Renal function and cardiovascular events in predialysis care. Sci Rep. 2026; DOI:10.1038/s41598-026-54285-7
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