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Prediction of cardiovascular outcome by estimated glomerular filtration rate among high-risk patients: a Thai nationwide cohort study

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Abstract

Background

Decline of estimated glomerular filtration rate (eGFR) is associated with increased cardiovascular (CV) morbidity and mortality, but the predictive value of different eGFR on CV outcomes is limited in Southeast Asian populations.

Aims

We aimed to stratify CV outcomes according to renal function among Thai patients with high atherosclerosis risk.

Methods

We performed a secondary analysis in a 5-year national cohort entitled “CORE-Thailand study.” Subjects were classified in 6 groups according to baseline kidney function: group I, eGFR ≥ 90; group II, eGFR 60–89; group IIIa, eGFR 45–59; group IIIb, eGFR 30–44; group IV, eGFR 15–29; group V, eGFR < 15 ml/min/1.73 m2 or receiving renal replacement therapy. The primary outcome was 4-point major adverse cardiovascular events (MACE). Secondary outcomes included all-cause mortality, CV mortality, hospitalization for heart failure, nonfatal myocardial infarction, and nonfatal stroke.

Results

A total of 6376 subjects (3467 men and 2909 women) were categorized in 6 groups. After adjusting covariates in the Cox proportional hazards model, compared to group I, subjects in groups II–V had a 1.65-fold, 2.17-fold, 2.67-fold, 4.24-fold, and 4.87-fold risk for 4-point MACE, respectively, with statistical significance at P < 0.05 in all groups. Kaplan–Meier analysis illustrated stepwise lower survivals from 4-point MACE following the groups with lower baseline eGFR (log-rank test with P < 0.001). All secondary outcomes showed similar trends as the primary outcome, except nonfatal stroke.

Conclusion

Lower baseline kidney function was independently associated with increased risk of CV events and all-cause mortality in Thai populations at high CV risk.

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Acknowledgements

We thank the investigators and research assistants associated with the CORE-Thailand study. The study was also supported by the Heart Association of Thailand under the Royal Patronage of HM the King and the National Research Council of Thailand.

Funding

No funding sources supported this study.

Author information

Authors and Affiliations

  1. Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand

    Noppawit Aiumtrakul, Annop Kittithaworn, Ouppatham Supasyndh & Bancha Satirapoj

  2. Division of Cardiology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Rungroj Krittayaphong

  3. Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

    Arintaya Phrommintikul

Authors
  1. Noppawit Aiumtrakul
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  2. Annop Kittithaworn
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  4. Rungroj Krittayaphong
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  5. Arintaya Phrommintikul
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Contributions

NA, AK and BS reviewed the literature, provided valuable input in designing the study, drafted the article and revised it critically. OS, RK, and AP provided literature review and critically revised the manuscript. All authors read and approved the manuscript and met the criteria for authorship.

Corresponding author

Correspondence to Noppawit Aiumtrakul.

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Conflict of interest

The authors declare that no potential conflict of interest exists.

Ethical approval

The Joint Research Ethics Committee and Ministry of Public Health, Thailand, approved the study protocol. Informed consent was obtained from all subjects.

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Aiumtrakul, N., Kittithaworn, A., Supasyndh, O. et al. Prediction of cardiovascular outcome by estimated glomerular filtration rate among high-risk patients: a Thai nationwide cohort study. Clin Exp Nephrol 26, 1180–1193 (2022). https://doi.org/10.1007/s10157-022-02262-5

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  • DOI: https://doi.org/10.1007/s10157-022-02262-5

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