(222) Cardiovascular and Renal Complications Among Patients with Chronic Kidney Disease (CKD) in the Netherlands

Publication Number: 896

Background: Cardiovascular and renal complications are common complications among patients with CKD, especially among those with type 2 diabetes (T2D) and/or heart failure (HF).

Objectives: To determine the prevalence of CKD and renal and cardiovascular complications among patients with CKD, T2D and/or HF in the Netherlands.

Methods: This cohort study used data from the PHARMO Database Network. From its GP Database, CKD was defined as a CKD diagnosis and/or ≥2 estimated glomerular filtration rate (eGFR) measurements at least 90 days apart. For CKD stage 1 and 2 (i.e. eGFR measurements ≥60 mL/min/1.73 m2) an urine albumin-to-creatinine ratio (UACR) measurement ≥30 mg/g was required. The prevalence of CKD was determined on December 31, 2019. In a representative subset of these patients who had CKD at December 31, 2017 and data on hospital admissions available, renal and cardiovascular complications were examined. Patients were categorised into subgroups for co-existence of T2D, HF, and T2D+HF. The occurrence of hospital admissions of cardiovascular and renal complications, and death was determined during 2 years of follow-up. Descriptive statistics were used for all analyses. Incidence rates (IRs) were calculated by dividing the number of patients with an admission by the number of person years (PY) and presented per 1,000 PY.

Results: In a population of 2,187,962 people, the prevalence of CKD was 8.9%. For the analyses regarding complications, 112,050 patients with CKD were included in the representative subset. Mean (SD) age was 72 (12) years and 57% was female. Of these patients, 19.9% had T2D, 7.7% had HF, and 3.0% had T2D+HF. Among patients with CKD only, hospital admissions for stroke and CKD were the most common cardiovascular and renal complications (IR: 9.5 and 5.0 / 1,000 PY, respectively). Among patients with CKD and T2D, the most frequent hospital admissions were stroke (IR: 12 / 1,000 PY) and HF (IR: 8.2 / 1,000 PY). Among patients with CKD and HF and among patients with CKD and T2D+HF, the most frequent hospital admissions were HF (IR: 46 and 67 / 1,000 PY, respectively) and cardiorenal syndrome (IR: 26 and 42 / 1,000 PY, respectively). The death rates were 8.5 / 1,000 PY (CKD only), 9.8 / 1,000 PY (CKD and T2D), 43 / 1,000 PY (CKD and HF), and 43 / 1,000 PY (CKD and T2D+HF). All IRs were higher among patients with CKD and T2D and/or HF.

Conclusions: Co-existence of T2D and/or HF next to CKD increases the risk of being hospitalised for cardiovascular and renal complications, and death. Preventive or early management of these complications can improve health in patients with CKD, T2D and/or HF.