BACKGROUND Cardiorenal syndrome is a well known concept, bolstered by extensive investigations of CKD as a risk factor of cardiovascular disease. However, data on whether cardiovascular disease increases long-term risk of ESKD are sparse. METHODS We assessed the association of incident hospitalization with major cardiovascular diseases (heart failure, atrial fibrillation, coronary heart disease, and stroke) with subsequent risk of ESKD among individuals enrolled in the Atherosclerosis Risk in Communities study; the analysis included 9047 individuals without prevalent cardiovascular disease at their fourth study visit. Each relevant incident cardiovascular disease event was entered into multivariable Cox proportional hazard models as a time-varying exposure to estimate hazard ratios. RESULTS During a median follow-up of 17.5 years, there were 2598 cases of hospitalization with cardiovascular disease (heart failure, n=1269; atrial fibrillation, n=1337; coronary heart disease, n=696; and stroke, n=559) and 210 cases of incident ESKD. The incidence of major cardiovascular disease was associated with increased risk of ESKD, with the highest risk for heart failure (hazard ratio, 11.40; 95% confidence interval, 8.38 to 15.50), followed by coronary heart disease, atrial fibrillation, and stroke. When we analyzed heart failure with preserved ejection fraction and heart failure with reduced ejection fraction separately, the risk was nominally higher for heart failure with preserved ejection fraction. CONCLUSIONS Major incident cardiovascular disease events were associated with ESKD, independent of kidney risk factors. In particular, heart failure showed a very strong association with ESKD. Our findings highlight the importance of monitoring and managing kidney disease in patients with cardiovascular disease. The potentially distinct contribution to ESKD of heart failure with preserved versus reduced ejection fraction deserves future investigation.

中文翻译：

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重大心血管疾病的突发事件住院治疗和随后的ESKD风险：对心肾综合征的影响。

背景技术心肾综合征是众所周知的概念，其通过广泛研究作为心血管疾病危险因素的CKD得到了支持。但是，关于心血管疾病是否会增加ESKD长期风险的数据很少。方法我们评估了参加社区动脉粥样硬化风险研究的个体中，住院事件与主要心血管疾病（心力衰竭，心房颤动，冠心病和中风）与随后的ESKD风险之间的关系。该分析包括9047位在第四次研究访问时未患上常见心血管疾病的人。将每个相关的心血管疾病事件作为时变暴露量输入多变量Cox比例风险模型中，以估算风险比。结果在平均17.5年的随访中，有2598例因心血管疾病住院的病例（心力衰竭，n = 1269；心房颤动，n = 1337；冠心病，n = 696；中风，n = 559）和210例ESKD事件。主要心血管疾病的发生与ESKD风险增加相关，心衰风险最高（风险比为11.40； 95％置信区间为8.38至15.50），其次是冠心病，心房纤颤和中风。当我们分别分析射血分数保留的心力衰竭和射血分数降低的心力衰竭时，射血分数保留的心力衰竭风险在名义上较高。结论主要的心血管疾病事件与ESKD相关，与肾脏危险因素无关。尤其是，心力衰竭与ESKD密切相关。我们的发现强调了在心血管疾病患者中监测和管理肾脏疾病的重要性。保留射血分数与减少射血分数对心力衰竭ESKD的潜在独特贡献值得进一步研究。