Association between chronic obstructive pulmonary disease and chronic kidney disease in vascular surgery patients

• Published in: Nephrology, dialysis, transplantation Vol. 24; no. 9; pp. 2763 - 2767
• Main Authors: van Gestel, Yvette R. B. M., Chonchol, Michel, Hoeks, Sanne E., Welten, Gijs M. J. M., Stam, Henk, Mertens, Frans W., van Domburg, Ron T., Poldermans, Don
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.09.2009; Oxford Publishing Limited (England)
• Subjects: Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; chronic kidney disease; chronic obstructive pulmonary disease; Cohort Studies; Emergency and intensive care: renal failure. Dialysis management; Female; Glomerular Filtration Rate; Humans; Intensive care medicine; Logistic Models; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Netherlands - epidemiology; Peripheral Vascular Diseases - complications; Peripheral Vascular Diseases - surgery; Pulmonary Disease, Chronic Obstructive - complications; Renal failure; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - mortality; Renal Insufficiency, Chronic - physiopathology; Risk Factors; vascular surgery; Vascular Surgical Procedures; Netherlands; vascular surgery; chronic kidney disease; chronic obstructive pulmonary disease; Human; Kidney disease; Lung disease; Urinary system disease; Respiratory disease; Hemodialysis; Cardiovascular disease; Vascular disease; Extrarenal dialysis; Surgery; Renal failure; Bronchus disease; Obstructive pulmonary disease
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfp171

Background. Chronic obstructive pulmonary disease (COPD) is recognized as a source of systemic inflammation and is associated with the development of cardiovascular disease. However, little is known about the association between COPD and chronic kidney disease (CKD). Therefore, we investigated the relationship between COPD and CKD and the association between COPD and mortality in patients with CKD. Methods. We conducted a cohort study of 3358 vascular surgery patients between 1990 and 2006. CKD was defined according to the Modification of Diet in Renal Disease equation as an estimated glomerular filtration rate (GFR) <60 mL/min/1.73 m2. In addition, the patients were divided into three categories based on the baseline estimated GFR: ≥90 mL/min/1.73 m2; 60–89 mL/min/1.73 m2 and <60 mL/min/1.73 m2. Multivariable logistic regression analysis was used to evaluate the independent association between prevalent COPD and CKD. Results. The prevalence of COPD was inversely related to kidney function. COPD was present in 47, 38 and 32% of patients with an estimated GFR <60, 60–89 and ≥90 mL/min/1.73 m2, respectively. COPD was independently associated with CKD (OR 1.22; 95% CI 1.03–1.44; P = 0.03). This association was strongest in patients with moderate COPD (OR 1.33; 95% CI 1.07–1.65; P = 0.01). Both moderate and severe COPD were associated with increased long-term mortality in patients with CKD (HR 1.27; 95% CI 1.03–1.56; P = 0.03 and HR 1.61; 95% CI 1.10–2.35; P = 0.01, respectively), compared to patients without COPD. Conclusions. Our findings indicate that COPD is moderately associated with CKD in a large cohort of vascular surgery patients. In addition, moderate and severe COPD are related to increased long-term mortality in patients with CKD.