Association of chronic kidney disease and cardiovascular disease risk with all-cause mortality: an interaction, joint and mediation analysis in Chinese adults.

BACKGROUND

Chronic kidney disease (CKD) is a global public health problem. This study aimed to evaluate the complex relationship of CKD and cardiovascular disease (CVD) risk with mortality in different age groups and the mediation effect of CVD risk among Chinese adults.

METHODS

A total of 7533 participants from the 2009 wave of China Health and Nutrition Survey (CHNS) cohort were included in this study and followed up to 2015. CKD was defined as the estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73m. Framingham risk score (FRS) was used to assess CVD risk. The interaction, joint association of CVD risk and CKD on mortality, and subsequent mediation effect were evaluated using multivariable Cox regression.

RESULTS

CHNS cohort recorded 266 deaths over a mean follow-up time of 5.04 years. The all-mortality rates among adults with CKD and high CVD risk were significantly higher than healthy controls (22.48 and 21.30 per 1000 person-years). After adjusting for covariates of age, gender, BMI, hypertension, diabetes, hyperuricemia, smoking status, and alcohol consumption, the adjusted hazard ratios (aHR) of CKD and high CVD risk were 1.70 (95% CI 1.27-2.28) and 1.62 (95%CI 1.26-2.09), respectively. Joint effect analysis revealed that mortality hazard was highest in CKD patients with high CVD risk (aHR = 3.15, 95% CI 1.92-5.16). Mediation analysis showed that significant partial mediation by SBP and fasting glucose, accounting for 19.2% (p < 0.001) and 3.52% (p = 0.012) of the total effect of CKD on mortality.

CONCLUSIONS

Comprehensive strategies including lifestyle modifications, diet restrictions, and cardio-nephrology multidisciplinary treatment for mitigating CVD risk in CKD patients should focus on middle-aged people and early disease detection.