Major cardiovascular events and subsequent risk of kidney failure with replacement therapy: a CKD Prognosis Consortium study

Patrick B. Mark, Juan J. Carrero, Kunihiro Matsushita, Yingying Sang, Shoshana H. Ballew, Morgan E. Grams (Lead / Corresponding author), Josef Coresh (Lead / Corresponding author), Aditya Surapaneni, Nigel J. Brunskill, John Chalmers, Lili Chan, Alex R. Chang, Rajkumar Chinnadurai, Gabriel Chodick, Massimo Cirillo, Dick de Zeeuw, Marie Evans, Amit X. Garg, Orlando M. Gutierrez, Hiddo J. L. HeerspinkGunnar H. Heine, William G. Herrington, Junichi Ishigami, Florian Kronenberg, Jun Young Lee, Adeera Levin, Rupert W. Major, Angharad Marks, Girish N. Nadkarni, David M. J. Naimark, Christoph Nowak, Mahboob Rahman, Charumathi Sabanayagam, Jung-Im Shin, Moneeza K. Siddiqui, Nikita Stempniewicz, Keiichi Sumida, José M. Valdivielso, Jan van den Brand, Angela Yee-Moon Wang, David C. Wheeler, Lihua Zhang, Frank L. J. Visseren, Benedicte Stengel

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Aims: Chronic kidney disease (CKD) increases risk of cardiovascular disease (CVD). Less is known about how CVD associates with future risk of kidney failure with replacement therapy (KFRT).

Methods and results: The study included 25 903 761 individuals from the CKD Prognosis Consortium with known baseline estimated glomerular filtration rate (eGFR) and evaluated the impact of prevalent and incident coronary heart disease (CHD), stroke, heart failure (HF), and atrial fibrillation (AF) events as time-varying exposures on KFRT outcomes. Mean age was 53 (standard deviation 17) years and mean eGFR was 89 mL/min/1.73 m2, 15% had diabetes and 8.4% had urinary albumin-to-creatinine ratio (ACR) available (median 13 mg/g); 9.5% had prevalent CHD, 3.2% prior stroke, 3.3% HF, and 4.4% prior AF. During follow-up, there were 269 142 CHD, 311 021 stroke, 712 556 HF, and 605 596 AF incident events and 101 044 (0.4%) patients experienced KFRT. Both prevalent and incident CVD were associated with subsequent KFRT with adjusted hazard ratios (HRs) of 3.1 [95% confidence interval (CI): 2.9–3.3], 2.0 (1.9–2.1), 4.5 (4.2–4.9), 2.8 (2.7–3.1) after incident CHD, stroke, HF and AF, respectively. HRs were highest in first 3 months post-CVD incidence declining to baseline after 3 years. Incident HF hospitalizations showed the strongest association with KFRT [HR 46 (95% CI: 43–50) within 3 months] after adjustment for other CVD subtype incidence.

Conclusion: Incident CVD events strongly and independently associate with future KFRT risk, most notably after HF, then CHD, stroke, and AF. Optimal strategies for addressing the dramatic risk of KFRT following CVD events are needed.
Original languageEnglish
Pages (from-to)1157–1166
Number of pages10
JournalEuropean Heart Journal
Issue number13
Early online date24 Jan 2023
Publication statusPublished - 1 Apr 2023


  • Cardiovascular disease
  • Heart failure
  • Kidney failure
  • eGFR
  • Albuminuria

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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