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Excess risk of cardiovascular events in patients in the United States vs. Japan with chronic kidney disease is mediated mainly by left ventricular structure and function.
Imaizumi, Takahiro; Fujii, Naohiko; Hamano, Takayuki; Yang, Wei; Taguri, Masataka; Kansal, Mayank; Mehta, Rupal; Shafi, Tariq; Taliercio, Jonathan; Go, Alan; Rao, Panduranga; Hamm, L Lee; Deo, Rajat; Maruyama, Shoichi; Fukagawa, Masafumi; Feldman, Harold I.
Afiliación
  • Imaizumi T; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Advanced Medicine, Nagoy
  • Fujii N; Medical and Research Center for Nephrology and Transplantation, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Hyogo, Japan.
  • Hamano T; Department of Nephrology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan; Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan. Electronic address: hamatea@med.nagoya-cu.ac.jp.
  • Yang W; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
  • Taguri M; Department of Health Data Science, Tokyo Medical University, Tokyo, Japan.
  • Kansal M; Department of Medicine, School of Medicine, University of Illinois, Chicago, Illinois, USA.
  • Mehta R; Division of Nephrology and Hypertension, Department of Medicine and Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Chicago, Illinois, USA; Department of Preventive Medicine Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
  • Shafi T; School of Medicine, John Hopkins University, Baltimore, Maryland, USA.
  • Taliercio J; Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, Ohio, USA.
  • Go A; Departments of Epidemiology, Biostatistics and Medicine, University of California at San Francisco, San Francisco, California, USA.
  • Rao P; Department of Internal Medicine, Division of Nephrology, University of Michigan Health System, Ann Arbor, Michigan, USA.
  • Hamm LL; Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA.
  • Deo R; Departments of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
  • Maruyama S; Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
  • Fukagawa M; Department of Internal Medicine, Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
  • Feldman HI; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Kidney Int ; 103(5): 949-961, 2023 05.
Article en En | MEDLINE | ID: mdl-36738890
While patients receiving dialysis therapy in the United States are more likely to develop cardiovascular disease (CVD) than those in Japan, direct comparisons of patients with predialysis chronic kidney disease (CKD) are rare. To study this, we compared various outcomes in patients with predialysis CKD using data from the Chronic Renal Insufficiency Cohort (CRIC) and CKD Japan Cohort (CKD-JAC) studies and determined mediators of any differences. Candidate mediators included left ventricular (LV) indices assessed by echocardiography. Among 3125 CRIC and 1097 CKD-JAC participants, the mean LV mass index (LVMI) and ejection fraction (EF) were 55.7 and 46.6 g/m2 and 54% and 65%, respectively (both significant). The difference in body mass index (32 and 24 kg/m2, respectively) largely accounted for the differences in LVMI and C-reactive protein levels across cohorts. Low EF and high LVMI were significantly associated with subsequent CVD in both cohorts. During a median follow-up of five years, CRIC participants were at higher risk for CVD (adjusted hazard ratio [95% confidence interval]: 3.66 [2.74-4.89]) and death (4.69 [3.05-7.19]). A three-fold higher C-reactive protein concentration and higher phosphate levels in the United States cohort were moderately strong mediators of the differences in CVD. However, echocardiographic parameters were stronger mediators than these laboratory measures. LVMI, EF and their combination mediated the observed difference in CVD (27%, 50%, and 57%, respectively) and congestive heart failure (33%, 62%, and 70%, respectively). Thus, higher LV mass and lower EF, even in the normal range, were found to be predictive of CVD in CKD.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Enfermedades Cardiovasculares / Insuficiencia Renal Crónica Tipo de estudio: Diagnostic_studies / Etiology_studies / Prognostic_studies / Risk_factors_studies Límite: Humans País/Región como asunto: America do norte / Asia Idioma: En Revista: Kidney Int Año: 2023 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Enfermedades Cardiovasculares / Insuficiencia Renal Crónica Tipo de estudio: Diagnostic_studies / Etiology_studies / Prognostic_studies / Risk_factors_studies Límite: Humans País/Región como asunto: America do norte / Asia Idioma: En Revista: Kidney Int Año: 2023 Tipo del documento: Article Pais de publicación: Estados Unidos