Funding: This study was supported by a grant-in-aid from the National Health and Medical Research Council of Australia and National Kidney Foundation of New Zealand. S. Zoungas and H. Teede are both supported by National Health and Medical Research Council of Australia Research Fellowships.
Advanced chronic kidney disease, cardiovascular events and the effect of diabetes: data from the Atherosclerosis and Folic Acid Supplementation Trial
Version of Record online: 18 MAR 2010
© 2011 The Authors. Internal Medicine Journal © 2011 Royal Australasian College of Physicians
Internal Medicine Journal
Volume 41, Issue 12, pages 825–832, December 2011
How to Cite
Zoungas, S., Lui, M., Kerr, P. G., Teede, H. J., McNeil, J. J., McGrath, B. P. and Polkinghorne, K. R. (2011), Advanced chronic kidney disease, cardiovascular events and the effect of diabetes: data from the Atherosclerosis and Folic Acid Supplementation Trial. Internal Medicine Journal, 41: 825–832. doi: 10.1111/j.1445-5994.2010.02226.x
Conflict of interest: None.
- Issue online: 18 MAR 2010
- Version of Record online: 18 MAR 2010
- Accepted manuscript online: 4 AUG 2010 12:15PM EST
- Received 6 December 2009; accepted 22 February 2010.
- chronic kidney disease;
- diabetes mellitus;
- cardiovascular disease;
- peripheral vascular disease;
- risk factor
Background: End-stage kidney disease registry data have reported increased mortality in patients with diabetes as compared with those without. Here we examine whether diabetes is independently associated with an increased risk of major cardiovascular events and death in patients with advanced chronic kidney disease (CKD).
Methods: Data from 315 participants with CKD in the Atherosclerosis and Folic Acid Supplementation Trial (ASFAST) were assessed. Primary end-points were fatal or non-fatal cardiovascular events, including myocardial infarction, stroke, unstable angina, coronary revascularisation and peripheral vascular events assessed both jointly and separately using Cox-proportional hazard models.
Results: Twenty-three per cent reported diabetes. Median follow up was 3.6 years. In those with diabetes, an increased risk for major cardiovascular events was observed, crude hazard ratio (HR) 2.87 (95% confidence interval (CI) 2.11–3.90). After adjustment for age, gender, smoking, systolic blood pressure, body mass index, past ischaemic heart disease and use of preventive therapies, diabetes was associated with an HR of 1.83 (1.28–2.61) for major cardiovascular events. The risk for peripheral vascular events was also increased, adjusted HR 6.31 (2.61–15.25). For all-cause death, major coronary and stroke events, the risk in those with diabetes was not significantly increased (all-cause death, adjusted HR 1.31 (95% CI 0.80–2.14); major coronary events, adjusted HR 1.26 (95% CI 0.64–2.49); and major stroke events, adjusted HR 1.28 (95% CI 0.55–2.99)).
Conclusions: Diabetes significantly increases the risk of major cardiovascular events, especially peripheral vascular events in patients with advanced CKD. Trials of multifactorial management of cardiovascular risk factors are required to determine if outcomes for this population may be improved.