Relative and Absolute Risk Reductions in Cardiovascular and Kidney Outcomes With Canagliflozin Across KDIGO Risk Categories: Findings From the CANVAS Program

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Association of Kidney Function Measures With Signs of Neurodegeneration and Small Vessel Disease on Brain Magnetic Resonance Imaging: The Atherosclerosis Risk in Communities (ARIC) Study

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Cardiovascular Risk Based on ASCVD and KDIGO Categories in Chinese Adults: A Nationwide,Population-Based,Prospective Cohort Study

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Kidney Function and Risk of Cardiovascular Disease and Mortality in Kidney Transplant Recipients: The FAVORIT Trial

In kidney transplant recipients, cardiovascular disease (CVD) is the leading cause of death. The relationship of kidney function with CVD outcomes in transplant recipients remains uncertain. We performed a post hoc analysis of the Folic Acid for Vascular Outcome Reduction in Transplantation (FAVORIT) Trial to assess risk factors for CVD and mortality in kidney transplant recipients. Following adjustment for demographic, clinical and transplant characteristics, and traditional CVD risk factors, proportional hazards models were used to explore the association of estimated GFR with incident CVD and all‐cause mortality. In 4016 participants, mean age was 52 years and 20% had prior CVD. Mean eGFR was 49±18 mL/min/1.73 m². In 3676 participants with complete data, there were 527 CVD events over a median of 3.8 years. Following adjustment, each 5 mL/min/1.73 m² higher eGFR at levels below 45 mL/min/1.73 m² was associated with a 15% lower risk of both CVD [HR = 0.85 (0.80, 0.90)] and death [HR = 0.85 (0.79, 0.90)], while there was no association between eGFR and outcomes at levels above 45 mL/min/1.73 m². In conclusion, in stable kidney transplant recipients, lower eGFR is independently associated with adverse events, suggesting that reduced kidney function itself rather than preexisting comorbidity may lead to CVD.     

Filtration Markers,Cardiovascular Disease,Mortality, and Kidney Outcomes in Stable Kidney Transplant Recipients: The FAVORIT Trial

Cystatin C and beta‐2‐microglobulin (B2M) are filtration markers associated with adverse outcomes in nontransplant populations, sometimes with stronger associations than for creatinine. We evaluated associations of estimated glomerular filtration rate from cystatin C (eGFR_cys), B2M (eGFR_B2M), and creatinine (eGFR_cr) with cardiovascular outcomes, mortality, and kidney failure in stable kidney transplant recipients using a case–cohort study nested within the Folic Acid for Vascular Outcome Reduction in Transplantation (FAVORIT) Trial. A random subcohort was selected (N = 508; mean age 51.6 years, median transplant vintage 4 years, 38% women, 23.6% nonwhite race) with enrichment for cardiovascular events (N = 306; 54 within the subcohort), mortality (N = 208; 68 within the subcohort), and kidney failure (N = 208; 52 within the subcohort). Mean eGFR_cr, eGFR_cys, and eGFR_B2M were 46.0, 43.8, and 48.8 mL/min/1.73m², respectively. After multivariable adjustment, hazard ratios for eGFR_cys and eGFR_B2M <30 versus 60+ were 2.02 (95% confidence interval [CI] 1.09–3.76; p = 0.03) and 2.56 (1.35–4.88; p = 0.004) for cardiovascular events; 3.92 (2.11–7.31) and 4.09 (2.21–7.54; both p < 0.001) for mortality; and 9.49 (4.28–21.00) and 15.53 (6.99–34.51; both p < 0.001) for kidney failure. Associations persisted with additional adjustment for baseline eGFR_cr. We conclude that cystatin C and B2M are strongly associated with cardiovascular events, mortality, and kidney failure in stable kidney transplant recipients.