Prediction of cardiovascular outcome by estimated glomerular filtration rate among high-risk patients: a Thai nationwide cohort study

• Published in: Clinical and experimental nephrology Vol. 26; no. 12; pp. 1180 - 1193
• Main Authors: Aiumtrakul, Noppawit, Kittithaworn, Annop, Supasyndh, Ouppatham, Krittayaphong, Rungroj, Phrommintikul, Arintaya, Satirapoj, Bancha
• Format: Journal Article
• Language: English
• Published: Singapore Springer Nature Singapore 01.12.2022; Springer Nature B.V
• Subjects: Arteriosclerosis; Cardiovascular diseases; Cerebral infarction; Congestive heart failure; Epidermal growth factor receptors; Glomerular filtration rate; Kidneys; Medicine; Medicine & Public Health; Morbidity; Mortality; Myocardial infarction; Nephrology; Original Article; Renal function; Risk groups; Stroke; Urology; Chronic kidney disease; High cardiovascular risk; Atherosclerosis; Glomerular filtration rate
• ISSN: 1342-1751; 1437-7799; 1437-7799
• DOI: 10.1007/s10157-022-02262-5

Background Decline of estimated glomerular filtration rate (eGFR) is associated with increased cardiovascular (CV) morbidity and mortality, but the predictive value of different eGFR on CV outcomes is limited in Southeast Asian populations. Aims We aimed to stratify CV outcomes according to renal function among Thai patients with high atherosclerosis risk. Methods We performed a secondary analysis in a 5-year national cohort entitled “CORE-Thailand study.” Subjects were classified in 6 groups according to baseline kidney function: group I, eGFR ≥ 90; group II, eGFR 60–89; group IIIa, eGFR 45–59; group IIIb, eGFR 30–44; group IV, eGFR 15–29; group V, eGFR < 15 ml/min/1.73 m 2 or receiving renal replacement therapy. The primary outcome was 4-point major adverse cardiovascular events (MACE). Secondary outcomes included all-cause mortality, CV mortality, hospitalization for heart failure, nonfatal myocardial infarction, and nonfatal stroke. Results A total of 6376 subjects (3467 men and 2909 women) were categorized in 6 groups. After adjusting covariates in the Cox proportional hazards model, compared to group I, subjects in groups II–V had a 1.65-fold, 2.17-fold, 2.67-fold, 4.24-fold, and 4.87-fold risk for 4-point MACE, respectively, with statistical significance at P  < 0.05 in all groups. Kaplan–Meier analysis illustrated stepwise lower survivals from 4-point MACE following the groups with lower baseline eGFR (log-rank test with P  < 0.001). All secondary outcomes showed similar trends as the primary outcome, except nonfatal stroke. Conclusion Lower baseline kidney function was independently associated with increased risk of CV events and all-cause mortality in Thai populations at high CV risk.