Urea levels and cardiovascular disease in patients with chronic kidney disease.
cardiovascular disease
chronic kidney disease
urea
uremic toxin
Journal
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
ISSN: 1460-2385
Titre abrégé: Nephrol Dial Transplant
Pays: England
ID NLM: 8706402
Informations de publication
Date de publication:
26 Feb 2022
26 Feb 2022
Historique:
entrez:
11
5
2022
pubmed:
12
5
2022
medline:
12
5
2022
Statut:
aheadofprint
Résumé
Elevated serum urea levels are common in moderate-to-advanced CKD. Several studies have shown that urea is a direct and indirect uremic toxin, especially with regard to cardiovascular disease. We sought to determine whether serum urea levels are associated with adverse cardiovascular events and death before renal replacement therapy (RRT) in patients with CKD. CKD-REIN is a prospective cohort of CKD nephrology outpatients not receiving maintenance dialysis. The 2507 patients included in the analysis were divided into three groups according to the baseline serum urea level (T1 < 10.5, T2:10.5 to 15.1, and T3 ≥ 15.1 mmol/L). Cox proportional hazard models were used to estimate hazard ratios (HRs) for first atheromatous or nonatheromatous cardiovascular (CV) events, and all-cause mortality before RRT. The models were adjusted for baseline comorbidities, laboratory data, and medications. Of the 2507 included patients (median [interquartile range (IQR)] age: 69[61-77]; mean (standard deviation) eGFR 33.5(11.6) mL/min/1.73 m²), 54% had a history of cardiovascular disease. After multiple adjustments for cardiovascular risk factors (including eGFR), patients in T3 had a higher risk of atheromatous and nonatheromatous cardiovascular events than patient in T1 (n events = 451, HR[95%CI]: 1.93[1.39-2.69]). The adjusted HRs for death before RRT (n events = 407) were 1.31[0.97; 1.76] and 1.73[1.22; 2.45] for patients T2 and those in T3, respectively. Our data suggested that urea is a predictor of cardiovascular outcomes beyond CV risk factors including eGFR.
Sections du résumé
BACKGROUND
BACKGROUND
Elevated serum urea levels are common in moderate-to-advanced CKD. Several studies have shown that urea is a direct and indirect uremic toxin, especially with regard to cardiovascular disease. We sought to determine whether serum urea levels are associated with adverse cardiovascular events and death before renal replacement therapy (RRT) in patients with CKD.
METHODS
METHODS
CKD-REIN is a prospective cohort of CKD nephrology outpatients not receiving maintenance dialysis. The 2507 patients included in the analysis were divided into three groups according to the baseline serum urea level (T1 < 10.5, T2:10.5 to 15.1, and T3 ≥ 15.1 mmol/L). Cox proportional hazard models were used to estimate hazard ratios (HRs) for first atheromatous or nonatheromatous cardiovascular (CV) events, and all-cause mortality before RRT. The models were adjusted for baseline comorbidities, laboratory data, and medications.
FINDINGS
RESULTS
Of the 2507 included patients (median [interquartile range (IQR)] age: 69[61-77]; mean (standard deviation) eGFR 33.5(11.6) mL/min/1.73 m²), 54% had a history of cardiovascular disease. After multiple adjustments for cardiovascular risk factors (including eGFR), patients in T3 had a higher risk of atheromatous and nonatheromatous cardiovascular events than patient in T1 (n events = 451, HR[95%CI]: 1.93[1.39-2.69]). The adjusted HRs for death before RRT (n events = 407) were 1.31[0.97; 1.76] and 1.73[1.22; 2.45] for patients T2 and those in T3, respectively.
INTERPRETATION
CONCLUSIONS
Our data suggested that urea is a predictor of cardiovascular outcomes beyond CV risk factors including eGFR.
Identifiants
pubmed: 35544273
pii: 6537416
doi: 10.1093/ndt/gfac045
pmc: PMC9869852
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Investigateurs
Carole Ayav
(C)
Serge Briançon
(S)
Dorothée Cannet
(D)
Christian Combe
(C)
Denis Fouque
(D)
Luc Frimat
(L)
Yves-Edouard Herpe
(YE)
Christian Jacquelinet
(C)
Maurice Laville
(M)
Ziad A Massy
(ZA)
Christophe Pascal
(C)
Bruce M Robinson
(BM)
Bénédicte Stengel
(B)
Céline Lange
(C)
Karine Legrand
(K)
Sophie Liabeuf
(S)
Marie Metzger
(M)
Elodie Speyer
(E)
Thierry Hannedouche
(T)
Bruno Moulin
(B)
Sébastien Mailliez
(S)
Gaétan Lebrun
(G)
Eric Magnant
(E)
Gabriel Choukroun
(G)
Benjamin Deroure
(B)
Adeline Lacraz
(A)
Guy Lambrey
(G)
Jean-Philippe Bourdenx
(JP)
Marie Essig
(M)
Thierry Lobbedez
(T)
Raymond Azar
(R)
Hacène Sekhri
(H)
Mustafa Smati
(M)
Mohamed Jamali
(M)
Alexandre Klein
(A)
Michel Delahousse
(M)
Christian Combe
(C)
Séverine Martin
(S)
Isabelle Landru
(I)
Eric Thervet
(E)
Ziad A Massy
(ZA)
Philippe Lang
(P)
Xavier Belenfant
(X)
Pablo Urena
(P)
Carlos Vela
(C)
Luc Frimat
(L)
Dominique Chauveau
(D)
Viktor Panescu
(V)
Christian Noel
(C)
François Glowacki
(F)
Maxime Hoffmann
(M)
Maryvonne Hourmant
(M)
Dominique Besnier
(D)
Angelo Testa
(A)
François Kuentz
(F)
Philippe Zaoui
(P)
Charles Chazot
(C)
Laurent Juillard
(L)
Stéphane Burtey
(S)
Adrien Keller
(A)
Nassim Kamar
(N)
Denis Fouque
(D)
Maurice Laville
(M)
Informations de copyright
© The Author(s) 2022. Published by Oxford University Press on behalf of the ERA.
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