Patients with chronic kidney disease (CKD) whose systolic blood pressure (SBP), LDL-C and fasting blood glucose (FBG) were controlled to target levels experienced a similar number of primary outcome events as patients without CKD, according to a new study published in JACC.

An analysis conducted by Tingting Geng, PhD, et al., from the Kailuan study, an ongoing prospective cohort community study of Chinese adults in Tangshan City, China, matched 20,254 patients with CKD (defined as estimated glomerular filtration rate [eGFR] <60 mL/min/1.73m2 or proteinuria ≥2+) with 35,236 participants without CKD, based on age (within two years) and sex.

Of patients with CKD, 15.4% had three risk factors controlled to target levels: SBP <130 mm Hg, LDL-C <2.6 mmol/L and FBG <6.1 mmol/L. Additionally, 42% had two of the three risk factors controlled, 33.5% had one controlled and 9.1% had none controlled. Those with more risk factors controlled tended to be younger, women, have a higher education level, and were not current smokers or drinkers.

Results showed that over the median follow-up of 12.2 to 12.8 years, in patients with CKD there was a dose-dependent reduction in the primary outcome of myocardial infarction (MI), stroke or death with more risk factors controlled. For patients with CKD with all three risk factors controlled, the hazard ratios (HR) were 0.80 for MI, 0.93 for stroke and 1.10 for all-cause mortality compared with patients without CKD.

Looking at patients with CKD and no risk factors at target levels, compared with the control group, the HRs were 1.83 for MI, 2.36 for stroke and 1.80 for all-cause mortality. Each additional controlled risk factor was associated with a 12% lower risk of CKD progression (HR, 0.88).

The researchers write that stringent risk factor control in patients with CKD "could theoretically eliminate the excess risk of [cardiovascular disease] and mortality associated with CKD."

"Observations in the Kailuan study cohort highlight the need for a holistic approach to managing patients with CKD, focusing on strict control of multiple cardiovascular risk factors," write Carmine Zoccali, MD, and Francesca Mallamaci, MD, in an accompanying editorial comment. "Future research should focus on confirming these findings in diverse populations and exploring the underlying mechanisms to enhance the management of CKD further."

Clinical Topics: Dyslipidemia, Lipid Metabolism, Nonstatins

Keywords: Cardiovascular Diseases, Cholesterol, LDL, Blood Glucose, Risk Factors, Myocardial Infarction, Renal Insufficiency, Chronic, Heart Disease Risk Factors, Blood Pressure