Affiliations 

  • 1 Department of Renal Medicine, Singapore General Hospital, Singapore
  • 2 Department of Medicine, National University of Singapore, National Univerity Health System, Singapore
  • 3 Singapore Eye Research Institute, Singapore
  • 4 Singapore Eye Research Institute, Singapore Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore
  • 5 Diabetes Centre, Khoo Teck Puat Hospital, Singapore
  • 6 National Registry of Diseases Office, Singapore
  • 7 School of Public Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  • 8 Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Graduate Medical School, National University of Singapore, Singapore
  • 9 Singapore Eye Research Institute, Singapore Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore Department of Ophthalmology, National University of Singapore, Singapore charumathi.sabanayagam@seri.com.sg
Eur J Prev Cardiol, 2015 Aug;22(8):1018-26.
PMID: 24857889 DOI: 10.1177/2047487314536873

Abstract

BACKGROUND: Few studies have examined the impact of chronic kidney disease (CKD) on adverse cardiovascular outcomes and deaths in Asian populations. We evaluated the associations of CKD with cardiovascular disease (CVD) and all-cause mortality in a multi-ethnic Asian population.
DESIGN: Prospective cohort study of 7098 individuals who participated in two independent population-based studies involving Malay adults (n = 3148) and a multi-ethnic cohort of Chinese, Malay and Indian adults (n = 3950).
METHODS: CKD was assessed from CKD-EPI estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR). Incident CVD (myocardial infarction, stroke and CVD mortality) and all-cause mortality were identified by linkage with national disease/death registries.
RESULTS: Over a median follow-up of 4.3 years, 4.6% developed CVD and 6.1% died. Risks of both CVD and all-cause mortality increased with decreasing eGFR and increasing albuminuria (all p-trend <0.05). Adjusted hazard ratios (HR (95% confidence interval)) of CVD and all-cause mortality were: 1.54 (1.05-2.27) and 2.21 (1.67-2.92) comparing eGFR <45 vs ≥60; 2.81 (1.49-5.29) and 2.34 (1.28-4.28) comparing UACR ≥300 vs <30. The association between eGFR <60 and all-cause mortality was stronger among those with diabetes (p-interaction = 0.02). PAR of incident CVD was greater among those with UACR ≥300 (12.9%) and that of all-cause mortality greater among those with eGFR <45 (16.5%).
CONCLUSIONS: In multi-ethnic Asian adults, lower eGFR and higher albuminuria were independently associated with incident CVD and all-cause mortality. These findings extend previously reported similar associations in Western populations to Asians and emphasize the need for early detection of CKD and intervention to prevent adverse outcomes.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.