Rationale & Objective

Little is known about the risk of cardiovascular disease (CVD) in patients with various primary glomerular diseases. In a population-level cohort of adults with primary glomerular disease, we sought to describe the risk of CVD compared with the general population and the impact of traditional and kidney-related risk factors on CVD risk.

Study Design

Observational cohort study.

Setting & Participants

Adults with membranous nephropathy (n = 387), minimal change disease (n = 226), IgA nephropathy (n = 759), and focal segmental glomerulosclerosis (n = 540) from a centralized pathology registry in British Columbia, Canada (2000-2012).

Exposure

Traditional CVD risk factors (diabetes, age, sex, dyslipidemia, hypertension, smoking, prior CVD) and kidney-related risk factors (type of glomerular disease, estimated glomerular filtration rate [eGFR], proteinuria).

Outcome

A composite CVD outcome of coronary artery, cerebrovascular, and peripheral vascular events, and death due to myocardial infarction or stroke.

Analytical Approach

Subdistribution hazards models to evaluate the outcome risk with non-CVD death treated as a competing event. Standardized incidence rates (SIR) calculated based on the age- and sex-matched general population.

Results

During a median 6.8 years of follow-up, 212 patients (11.1%) experienced the CVD outcome (10-year risk, 14.7% [95% CI, 12.8%-16.8%]). The incidence rate was high for the overall cohort (24.7 per 1,000 person-years) and for each disease type (range, 12.2-46.1 per 1,000 person-years), and was higher than that observed in the general population both overall (SIR, 2.46 [95% CI, 2.12-2.82]) and for each disease type (SIR range, 1.38-3.98). Disease type, baseline eGFR, and proteinuria were associated with a higher risk of CVD and, when added to a model with traditional risk factors, led to improvements in model fit (R² of 14.3% vs 12.7%), risk discrimination (C-statistic of 0.81 vs 0.78; difference, 0.02 [95% CI, 0.01-0.04]), and continuous net reclassification improvement (0.4 [95% CI, 0.2-0.6]).

Limitations

Ascertainment of outcomes and comorbidities using administrative data.

Conclusions

Patients with primary glomerular disease have a high absolute risk of CVD that is approximately 2.5 times that of the general population. Consideration of eGFR, proteinuria, and type of glomerular disease may improve risk stratification of CVD risk in these individuals.

Plain-Language Summary

Patients with chronic kidney disease are known to be at high risk of cardiovascular disease. Cardiovascular risk in patients with primary glomerular diseases is poorly understood because these conditions are rare and require a kidney biopsy for diagnosis. In this study of 1,912 Canadian patients with biopsy-proven IgA nephropathy, minimal change disease, focal segmental glomerulosclerosis, and membranous nephropathy, the rate of cardiovascular events was 2.5 times higher than in the general population and was high for each disease type. Consideration of disease type, kidney function, and proteinuria improved the prediction of cardiovascular events. In summary, our population-level study showed that patients with primary glomerular diseases have a high cardiovascular risk, and that inclusion of kidney-specific risk factors may improve risk stratification.

中文翻译：

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原发性肾小球疾病患者心血管事件的风险

理由和目标

对患有各种原发性肾小球疾病的患者患心血管疾病 (CVD) 的风险知之甚少。在患有原发性肾小球疾病的成年人人群水平队列中，我们试图描述与一般人群相比的 CVD 风险，以及传统和肾脏相关风险因素对 CVD 风险的影响。

学习规划

观察性队列研究。

设置和参与者

来自加拿大不列颠哥伦比亚省中央病理登记处的膜性肾病 (n = 387)、微小病变 (n = 226)、IgA 肾病 (n = 759) 和局灶节段性肾小球硬化 (n = 540) 成人（2000-2012） ).

接触

传统的 CVD 危险因素（糖尿病、年龄、性别、血脂异常、高血压、吸烟、既往 CVD）和肾脏相关危险因素（肾小球疾病类型、估计肾小球滤过率 [eGFR]、蛋白尿）。

结果

冠状动脉、脑血管和外周血管事件的复合 CVD 结果，以及因心肌梗塞或中风导致的死亡。

分析方法

用于评估将非 CVD 死亡视为竞争事件的结果风险的子分布风险模型。根据年龄和性别匹配的一般人群计算的标准化发病率 (SIR)。

结果

在中位 6.8 年的随访期间，212 名患者 (11.1%) 经历了 CVD 结果（10 年风险，14.7% [95% CI，12.8%-16.8%]）。整个队列（每 1,000 人年 24.7 例）和每种疾病类型（范围，每 1,000 人年 12.2-46.1 例）的发病率都很高，并且高于在总体人群中观察到的发病率（SIR， 2.46 [95% CI，2.12-2.82]）和每种疾病类型（SIR 范围，1.38-3.98）。疾病类型、基线 eGFR 和蛋白尿与较高的 CVD 风险相关，并且当添加到具有传统风险因素的模型时，导致模型拟合（R ²为 14.3% 对 12.7%）、风险歧视（C- 0.81 与 0.78 的统计数据；差异 0.02 [95% CI，0.01-0.04]）和持续的净重新分类改进（0.4 [95% CI，0.2-0.6]）。

限制

使用管理数据确定结果和合并症。

结论

患有原发性肾小球疾病的患者患 CVD 的绝对风险很高，约为一般人群的 2.5 倍。考虑 eGFR、蛋白尿和肾小球疾病的类型可能会改善这些个体 CVD 风险的风险分层。

通俗易懂的摘要

众所周知，慢性肾病患者患心血管疾病的风险很高。原发性肾小球疾病患者的心血管风险知之甚少，因为这些疾病很少见，需要肾活检才能诊断。在这项针对 1,912 名经活检证实患有 IgA 肾病、微小病变、局灶节段性肾小球硬化和膜性肾病的加拿大患者的研究中，心血管事件的发生率比一般人群高 2.5 倍，并且每种疾病类型的心血管事件发生率都很高。考虑疾病类型、肾功能和蛋白尿改善了心血管事件的预测。总之，我们的人口水平研究表明，患有原发性肾小球疾病的患者具有较高的心血管风险，