Cardiovascular risk modification in participants with coronary disease screened by the Kidney Early Evaluation Program

Background: Coronary artery disease (CAD) identifies the need for intensive treatment of risk factors among individuals with chronic kidney disease (CKD), a high-risk, complex cardiovascular risk state.Methods: An estimated glomerular filtration rate <60 mL/min/1.73 m ² or a urine albumin: creatinine ratio (ACR) ≥ 30 mg/g (3.4 mg/mmol) defined CKD.Results: Of 70 454 volunteers screened the mean age was 53.5 ± 15.7 years and 68.3% were female. A total of 5410 (7.7%) had a self-reported history of CAD; 1295 (1.8%) had a history of prior percutaneous coronary intervention (PCI); and 1124 (1.6%) had a prior history of coronary artery bypass surgery (CABG). Multivariate analysis for the outcome of suboptimal CAD risk management (composite of systolic blood pressure ≥130 mmHg, glucose ≥125 mg/dL (6.9 mmol/L) for diabetics, total cholesterol ≥200 mg/dL (5.2 mmol/L), or current smoking; n= 38 746/53 403, 72.5%) revealed older age (per year) (odds ratio (OR) = 1.04, 95% confidence interval (CI) 1.03-1.04, P < 0.0001), male gender (OR = 1.40, 95% CI 1.34-1.47, P < 0.0001), ACR ≥ 30 mg/g (3.4 mg/mmol) (OR = 1.66, 95% CI 1.55-1.79, P < 0.0001), body mass index (per kg/m ²) (OR = 1.06, 95% CI 1.06-1.06, P < 0.0001), CAD without a history of revascularization (OR = 1.14, 95% CI 1.02-1.28, P= 0.02) and care received by a nephrologist (OR = 1.49, 95% CI 1.22-1.83, P < 0.0001) were associated with worse risk factor control. Prior coronary revascularization and being under the care of a cardiologist were not associated with either improved or suboptimal risk factor control.Conclusions: Chronic kidney disease is associated with overall poor rates of CAD risk factor control.