Florens Nans, Aymes Estelle, Gauthier Victoria, Frimat Luc, Laville Maurice, Bedo Dimitri, Beaudrey Thomas, Amouyel Philippe, Mansencal Nicolas, Lange Céline, Liabeuf Sophie, Massy Ziad A, Stengel Benedicte, de Pinho Natalia Alencar, Hamroun Aghiles
Nephrology, Dialysis & Transplantation Department, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, 1 Place de l'hôpital, Strasbourg, France.
UMR1109 Molecular Immuno-Rhumatology, FHU TARGET, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, University of Strasbourg, Strasbourg, France.
Clin Kidney J. 2024 Dec 11;17(12):sfae337. doi: 10.1093/ckj/sfae337. eCollection 2024 Dec.
Cardiovascular diseases are a leading cause of morbidity and mortality in patients with chronic kidney disease (CKD). Acute kidney injury (AKI) has been increasingly recognized as a potential exacerbating factor for cardiovascular events in these patients. The CKD-REIN study aims to explore the relationship between AKI and the risk of major adverse cardiovascular events (MACE) in a cohort of CKD patients. We hypothesize that AKI is a significant and independent predictor of MACE in patients with CKD, and that the severity of AKI correlates with the risk of subsequent cardiovascular events.
This prospective cohort study included 3033 adult CKD patients from 40 outpatient nephrology clinics in France. Patients were followed for a median of 5.2 years. AKI episodes were identified and staged based on the KDIGO-AKI criteria. Cardiovascular events, including myocardial infarction, stroke, heart failure hospitalization, and cardiovascular death, were systematically recorded. The association between AKI and MACE was analyzed using a multivariable Cox model, adjusting for confounders such as demographic characteristics, medical history, and baseline kidney function.
During the follow-up, 530 patients experienced at least one episode of AKI. The cumulative incidence of MACE at 1 year post-AKI was 8.1%. Patients with AKI had a significantly increased risk of MACE, with an adjusted hazard ratio (HR) of 5.78 ( < .001). The risk was consistent across different MACE components and was independent of age, sex, CKD stage, or comorbidities. The risk of MACE was higher for more severe AKI stages and for AKI events requiring hospitalization or associated with incomplete renal recovery.
The findings of this study confirm that AKI is a significant independent predictor of MACE in CKD patients, demonstrating a strong severity-response relationship. These results underscore the importance of vigilant cardiovascular monitoring and preventive strategies in CKD patients following AKI episodes. Understanding the mechanisms linking AKI to cardiovascular outcomes is crucial for developing targeted interventions to mitigate these risks.
心血管疾病是慢性肾脏病（CKD）患者发病和死亡的主要原因。急性肾损伤（AKI）日益被认为是这些患者心血管事件的潜在加重因素。CKD-REIN研究旨在探讨CKD患者队列中AKI与主要不良心血管事件（MACE）风险之间的关系。我们假设AKI是CKD患者MACE的重要且独立预测因素，并且AKI的严重程度与随后心血管事件的风险相关。
这项前瞻性队列研究纳入了来自法国40家门诊肾病诊所的3033例成年CKD患者。对患者进行了中位时间为5.2年的随访。根据KDIGO-AKI标准识别并分期AKI发作。系统记录心血管事件，包括心肌梗死、中风、心力衰竭住院和心血管死亡。使用多变量Cox模型分析AKI与MACE之间的关联，并对人口统计学特征、病史和基线肾功能等混杂因素进行校正。
在随访期间，530例患者经历了至少一次AKI发作。AKI后1年MACE的累积发生率为8.1%。AKI患者发生MACE的风险显著增加，校正后的风险比（HR）为5.78（P<0.001）。该风险在不同的MACE组成部分中一致，并且独立于年龄、性别、CKD分期或合并症。更严重的AKI分期以及需要住院或与肾功能未完全恢复相关的AKI事件发生MACE的风险更高。
本研究结果证实AKI是CKD患者MACE的重要独立预测因素，显示出强烈的严重程度-反应关系。这些结果强调了在AKI发作后的CKD患者中进行警惕的心血管监测和预防策略的重要性。了解将AKI与心血管结局联系起来的机制对于制定有针对性的干预措施以减轻这些风险至关重要。
