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Patients Diagnosed With CKD ± DM Have a Greater
Likelihood of Death Than Those With ESRD
5% Medicare sample, 1996-1997 cohort, 2-year follow-up
n=1,045,263 188,596 33,586 19,335
100
80
Patients (%)
65.12
60 73.18 Event free
85.04
90.53
5.85 ESRD
40 2.25
Death
0.31
0.07
20
24.57 29.04
14.65
9.40
0
NDM/Non- DM/Non-CKD NDM/CKD DM/CKD
CKD Status in the Entry Period
Collins et al. Kidney Int. 2003;64(suppl 87):S24-S31.
Annual Rate (%) of Progression to
Albuminuria, Elevated Creatinine and Death
in 5000 Type 2 Diabetics
The United Kingdom Prospective Diabetes Study
Newly diagnosed, predominantly white, medically treated
1.4%
No albuminuria C
2.0% V
3.0%
Microalbuminuria
2.8% D
4.6% E
Macroalbuminuria
A
2.3% T
19%
Elevated serum creatinine
H
Adler et al. Kidney Int. 2003;63:225-232.
Relative Risk for Development of
Cardiovascular Disease in Atherosclerosis Risk
in Communities Study
Stage of Kidney Disease n
1.16
Stage 2 (GFR 60-89) 7665
1.38
Stage 3 and 4 (GFR 15-59) 444
Each 10 mL/min/1.73 m2 lower GFR was associated
with an adjusted hazard ratio of 1.05 (1.02, 1.09),
0.75 1.0 1.25 1.51.75 2.0
1.07 (1.01, 1.12), and 1.06 (0.99, 1.13) for ASCVD,
de novo ASCVD, and recurrent ASCVD
Manjunath et al. J Am Coll Cardiol. 2003;41:47-55.
Age-Adjusted Death, Cardiovascular Events,
and Hospitalization in Chronic Kidney Disease
1,120,295 Ambulatory Adults
Death CV Events Hospitalization
144.61
14.14
15 40 36.60 150
14 140
13 35 130
12 11.36 120
Events (per 100 person-years)
Rate of Death From Any Cause
11 30 110
Rate of Cardiovascular
Rate of Hospitalization
(per 100 person-years)
(per 100 person-years)
10 100 86.75
25 21.80
9 90
8 80
20
7 70
6 4.76 15 11.29 60 45.26
5 50
4 10 40
3 3.65 30 13.54 17.22
2 0.76 1.08 5 2.11 20
1 10
0 0 0
60 45-59 30-44 15-29 <15 60 45-59 30-44 15-29 <15 60 45-59 30-44 15-29 <15
Estimated GFR (mL/min/1.73 m2) Estimated GFR (mL/min/1.73 m2) Estimated GFR (mL/min/1.73 m2)
No. of Events 25,803 11,569 7802 4408 1842 73,108 34,690 18,580 8809 3824 366,757 106,543 49,177 20,581 11,593
Go et al. N Engl J Med. 2004;351:1296-1305.
Low GFR Is a Risk Factor for CV Outcome Post MI
GFR ≥75.0 mL/ GFR 60.0-74.9 mL/ GFR 45.0-59.9 mL/ GFR <45.0mL/
min/1.73 m2 min/1.73 m2 min/1.73 m2 min/1.73 m2
60
P<.001
Estimated Event Rate (%)
50
40
30
20
10
0
Death From Reinfarction CHF Stroke Resus- Composite
CV Causes citation End Point
Anavekar et al. N Engl J Med. 2004;351:1298-1295.
Chronic Kidney Disease and
Traditional Cardiovascular Risk Factors
Age
Glucose
Hypertension
Intolerance
Cardiovascular
Oxidative Stress Event Exercise
Dyslipidemia Family History
Smoking
Sarnak et al. Hypertension. 2003;42;1050-1065.
Proportion of Population and Estimated GFR
140/90 mm Hg or BP medication 160/100 mm Hg
95% confidence interval 95% confidence interval
100
Proportion of Population (%)
90
80 75% 77%
70 68%
60 55%
50 45%
40% 39% 42%
40
30 21%
20 15%
12% 10%
8% 7% 6%
10 6%
0
15 30 60 90 120
Estimated GFR (mL/min/1.73 m2)
Prevalence of high blood pressure by level of GFR, adjusted to age 60 years (NHANES III).
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