Primary Glomerular Disease Associated With High CVD Risk
Get authentic, real-time news that helps you fight COVID-19 better.
Install PlexusMD App for doctors. It's free.
In a population-level observational cohort study of adults with primary glomerular disease, we sought to describe the risk of CVD compared to the general population and the impact of traditional and kidney-related risk factors on CVD risk. Adults with membranous nephropathy (n=387), minimal change disease (n=226), IgA nephropathy (n=759), and FSGS (n=540) from a centralized pathology registry in British Columbia, Canada (2000-2012). Exposures-Traditional CVD risk factors (diabetes, age, sex, dyslipidemia, hypertension, smoking, prior CVD) and kidney-related risk factors (type of glomerular disease, eGFR, proteinuria). Outcome- A composite CVD outcome of coronary artery, cerebrovascular, and peripheral vascular events, and death due to myocardial infarction or stroke.

During a median 6.8 years of follow-up, 212 (11.1%) patients experienced CVD (10-year risk 14.7%, 95% CI 12.8-16.8). The incidence rate was high for the overall cohort (24.7 per 1000 person-years) and for each disease type (range 12.2-46.1 per 1000 person-years), and was higher than that observed in the general population both overall (SIR 2.46, 95% CI 2.12-2.82) and for each disease type (SIR range 1.38-3.98). Disease type, baseline eGFR, and proteinuria were associated with a higher risk of CVD and, when added to a model with traditional risk factors, led to improvements in model fit (R2 14.3% vs 12.7%), risk discrimination (C-statistic 0.81 vs 0.78, difference 0.02, 95% CI 0.01-0.04) and continuous net reclassification improvement (0.4, 95% CI 0.2-0.6).

Patients with primary glomerular disease have a high absolute risk of CVD that is approximately 2.5 times that of the general population. Consideration of eGFR, proteinuria, and type of glomerular disease may improve risk stratification of CVD in these individuals.