Hidden chronic renal insufficiency and cardiovascular events in patients with hypertension in a primary care center.

OBJECTIVES: The aims of this study were to evaluate whether hidden chronic renal insufficiency (CRI) may be considered an independent cardiovascular risk factor in patients with hypertension and to calculate cardiovascular risk in this population. METHODS: A total of 756 hypertensive patients of ages from 35 to 74 years (mean 57.0 years; 58.2% women) and without evidence of cardiovascular disease were studied and followed during 10 years. Their glomerular filtration rate (GFR) was estimated using the simplified MDRD (result of the Modification of Diet in Renal Disease study) and Cockcroft-Gault formulas. Hidden CRI was identified by a GFR <60 mL/min/1.73 m(2) with normal serum creatinine concentration (<1.4 mg/dL men; <1.3 mg/dL women). RESULTS: Of the patients with hidden CRI using the MDRD equation, 22% presented cardiovascular events (RR, 1.60; 95% confidence interval (CI), 1.06-2.43; p < 0.05). While the estimated coronary risk using the original Framingham function was similar in patients with and without hidden CRI (18.2%), using the REGICOR function it was higher in those with CRI (7.7 vs. 7.2%, p < 0.05). Logistic regression analysis showed that smoking, male sex, age, and diastolic blood pressure were predictors of cardiovascular events. The presence of hidden CRI was not a statistically significant predictor using either the MDRD (OR, 1.37; 95% CI, 0.72-2.61; p = 0.340) or the Cockcroft-Gault (OR, 1.05; 95% CI, 0.50-2.23; p = 0.893) formulas. CONCLUSIONS: The hypertensive population of 35-74 years in age with hidden CRI showed a higher incidence of cardiovascular events, but hidden CRI may not be considered an independent cardiovascular risk factor.

[Cardiovascular risk in patients with renal failure]. / Riesgo cardiovascular en pacientes con insuficiencia renal.

BACKGROUND AND OBJECTIVE: Patients with renal failure (RF) have an increased risk of cardiovascular events. The aims of the present study were: a) to evaluate if RF is an independent cardiovascular risk factor, and b) to analyze the predictive capacity of the original Framingham and REGICOR functions charts in patients with RF. PATIENTS AND METHOD: A total of 912 patients between 35-74 years old (average: 55.7 years; 56.4% female) with no evidence of cardiovascular disease, were included in the present study. The RF was defined in patients with a glomerular filtration < 60 ml/min (estimated with the equation of Cockroft-Gaukt). RESULTS: 13.5% of the patients presented RF criteria. The final rate of cardiovascular events was higher in the population with RF (21.1% vs 12.0%; p < 0.01; relative risk = 1.76; 95% confidence interval [CI], 1.19-2.59). Statistically significant differences were not found between men and women. The multiple logistic regression analysis showed that cigarette smoking (odds ratio [OR] = 2.17; 95% CI, 1.38-3.35), diabetes (OR = 2.08; 95% CI, 1.37-3.15), RF (OR = 1.83; 95% CI, 1.10-3.06), antihypertensive treatment (OR = 2.03; IC del 95%, 1.32-3.11), and hypertension (OR = 2.06; 95% CI, 1.06-4.05) were important factors for the prediction of coronary and cardiovascular events. The original Framingham function predicted suitably the coronary risk in the population with RF (18.3% versus 17.9%; p = 0.869) whereas REGICOR underestimated it (7.5% versus 17.9%; p < 0.05). The area under the receiver operator characteristic (ROC) curve obtained with the original Framingham function was similar to that of REGICOR function: 0.61 (95% CI, 0.47-0.75) and 0.62 (95% CI, 0.48-0.76), respectively. CONCLUSIONS: The RF behaves like an important cardiovascular risk factor. The area under ROC curve obtained with the original Framingham function was similar to that of REGICOR function.

[Cardiovascular events in patients with hidden renal failure detected by equations of glomerular filtration]. / Episodios cardiovasculares en pacientes con insuficiencia renal oculta detectada mediante fórmulas de filtrado glomerular.

OBJECTIVE: The objective of this work was to value the relationship between cardiovascular disease and presence of hidden renal failure in patients between 35 and 74 years followed up for 10 years. DESIGN: Observational, longitudinal, retrospective study of a cohort of patients. SETTING: Primary care health centre. PARTICIPANTS: We studied 875 patients (average age, 55.6 years, with 57.4% women) without evidence of cardiovascular disease, cared for in an urban primary health centre. MEASUREMENTS AND MAIN RESULTS: Glomerular filtration was estimated using Cockcroft-Gault and simplified MDRD equations. Hidden renal failure was considered if the glomerular filtration was <60 mL/min with a normal serum creatinine concentration. Using the Cockcroft-Gault equation 11.2% of study population had hidden renal failure and 12% when using MDRD, and 16.3% of patients with hidden renal failure using Cockcroft-Gault equation had coronary events. The relative risk in this group was 1.8 (95% confidence interval [CI], 1.1-2.9; P< .05). The percentage of coronary events was 16.2% when glomerular filtration was estimated by MDRD (relative risk, 1.9; 95% CI, 1.2-3.1; P< .05). Binary logistic regression analysis showed that age, male sex, smoking, diabetes, and diastolic pressure were the predicting variables of cardiovascular events, the highest odds ratio corresponding to the smoking population. The presence of hidden renal failure was not statistically significant using either Cockcroft (odds ratio, 1.21; 95% CI, 0.64-2.28; P=.566) or MDRD (odds ratio, 1.64; 95% CI, 0.77-3.48; P=.200) CONCLUSIONS: The prevalence of occult renal dysfunction in the 35-74 years population is high, but it does not behave as an independent cardiovascular risk factor.

Riesgo cardiovascular en pacientes con insuficiencia renal / Cardiovascular risk in patients with renal failure

FUNDAMENTO Y OBJETIVO: El riesgo de presentar episodios cardiovasculares es elevado en pacientes con insuficiencia renal (IR). El presente estudio se diseñó con estos objetivos: a) evaluar si la IR se comporta como un factor independiente de riesgo cardiovascular, y b) analizar la capacidad predictiva de la función original de riesgo coronario de Framingham y la calibrada del REGICOR en pacientes con IR.PACIENTES Y MÉTODO: Se estudió a un total de 912 pacientes de 35-74 años (media, 55,7 años;un 56,4% de mujeres) sin evidencia de enfermedad cardiovascular, con un seguimiento de 10años. La IR se definió por la presencia de un filtrado glomerular estimado en la fórmula de Cockroft-Gault menor de 60 ml/min.RESULTADOS: El 13,5% de los pacientes reunía criterios de IR. La tasa final de episodios cardiovascularesfue superior en la población con IR (un 21,1 frente a un 12,0%; p < 0,01; riesgo relativo= 1,76; intervalo de confianza [IC] del 95%, 1,19-2,59), sin diferencias estadísticamente significativas entre varones y mujeres. En el análisis multivariante mediante regresión logística se mantuvieron como variables predictoras de eventos cardiovasculares el tabaquismo (odds ratio [OR] =2,17; IC del 95%, 1,38-3,35), la diabetes (OR = 2,08; IC del 95%, 1,37-3,15), la IR (OR =1,83; IC del 95%, 1,10-3,06), el tratamiento antihipertensivo (OR = 2,03; IC del 95%, 1,32-3,11) y la hipertensión arterial (OR = 2,06; IC del 95%, 1,06-4,05). La función original de Framingham predijo adecuadamente el riesgo coronario de la población con IR (un 18,3 frente a un 17,9%; p = 0,869), mientras que REGICOR lo infravaloró (un 7,5 frente a un 17,9%; p < 0,05). Las curvas de eficacia diagnóstica para la función original de Framingham y la REGICOR fueron similares: 0,61 (IC del 95%, 0,47-0,75) y 0,62 (IC del 95%, 0,48-0,76), respectivamente.CONCLUSIONES: La IR se comporta como un importante factor de riesgo cardiovascular. Las curvasde eficacia diagnóstica son similares en ambas funciones de riesgo coronario, Framingham y REGICOR

BACKGROUND AND OBJECTIVE: Patients with renal failure (RF) have an increased risk of cardiovascularevents. The aims of the present study were: a) to evaluate if RF is an independent cardiovascularrisk factor, and b) to analyze the predictive capacity of the original Framingham and REGICOR functions charts in patients with RF.PATIENTS AND METHOD: A total of 912 patients between 35-74 years old (average: 55.7 years; 56.4% female) with no evidence of cardiovascular disease, were included in the present study. The RF was defined in patients with a glomerular filtration < 60 ml/min (estimated with theequation of Cockroft-Gaukt).RESULTS: 13.5% of the patients presented RF criteria. The final rate of cardiovascular events washigher in the population with RF (21.1% vs 12.0%; p < 0.01; relative risk = 1.76; 95% confidenceinterval [CI], 1.19-2.59). Statistically significant differences were not found between men and women. The multiple logistic regression analysis showed that cigarette smoking (odds ratio [OR] = 2.17; 95% CI, 1.38-3.35), diabetes (OR = 2.08; 95% CI, 1.37-3.15), RF (OR = 1.83; 95% CI, 1.10-3.06), antihypertensive treatment (OR = 2.03; IC del 95%, 1.32-3.11), and hypertension(OR = 2.06; 95% CI, 1.06-4.05) were important factors for the prediction of coronary and cardiovascular events. The original Framingham function predicted suitably the coronary risk in the population with RF (18.3% versus 17.9%; p = 0.869) whereas REGICOR underestimated it (7.5% versus 17.9%; p < 0.05). The area under the receiver operator characteristic (ROC) curve obtained with the original Framingham function was similar to that of REGICOR function: 0.61(95% CI, 0.47-0.75) and 0.62 (95% CI, 0.48-0.76), respectively.CONCLUSIONS: The RF behaves like an important cardiovascular risk factor. The area under ROCcurve obtained with the original Framingham function was similar to that of REGICOR function

Episodios cardiovasculares en pacientes con insuficiencia renal oculta detectada mediante fórmulas de filtrado glomerular / Cardiovascular events in patients with hidden renal failure detected by equations of glomerular filtration

Objetivo. Valorar la relación entremorbimortalidad cardiovascular y presenciade insuficiencia renal oculta en pacientesde 35-74 años de edad seguidos durante10 años.Diseño. Estudio observacional, longitudinal,de una cohorte retrospectiva.Emplazamiento. Atención primaria, centrode salud.Participantes. Un total de 875 pacientes(media, 55,6 años; 57,4%,mujeres) sinevidencia de enfermedad cardiovascular.Resultados y mediciones principales. El filtradoglomerular se estimó mediante las fórmulasde Cockcroft-Gault y MDRD abreviada,derivada del estudio Modification of Dietin Renal Disease. Se consideró insuficienciarenal oculta la presencia de un filtradoglomerular inferior a 60 ml/min con cifrasnormales de creatinina. Un 11,2% de lapoblación tenía insuficiencia renal ocultausando la fórmula de Cockcroft-Gaulty un 12,0% según MDRD. Un 16,3% delos pacientes con insuficiencia renal ocultaen la fórmula de Cockcroft-Gault presentaronacontecimientos coronarios (RR = 1,8; IC del95%, 1,1-2,9; p < 0,05). El porcentaje fuedel 16,2% (RR = 1,9; IC del 95%, 1,2-3,1;p < 0,05) cuando el filtrado glomerular se estimócon MDRD. En el análisis de regresiónlogística se observó que la edad, el sexo varón,el tabaquismo, la diabetes y la presión arterialdiastólica fueron las variables predictorasde episodios cardiovasculares en los modelosfinales, correspondiendo al tabaquismolas mayores odds ratio (OR). La presenciade insuficiencia renal oculta no alcanzósignificación estadística cuando la definiciónse realizó con la fórmula de Cockcroft-Gault(OR = 1,21; IC del 95%, 0,64-2,28;p = 0,566) o con la de MDRD (OR = 1,64;IC del 95%, 0,77-3,48; p = 0,200).Conclusiones. En pacientes de 35-74 añosexiste una alta prevalencia de insuficienciarenal oculta, pero esta entidad no secomporta como un predictor independientede episodios cardiovasculares

Objective. The objective of this work wasto value the relationship betweencardiovascular disease and presence ofhidden renal failure in patients between35 and 74 years followed up for 10 years.Design. Observational, longitudinal,retrospective study of a cohort of patients.Setting. Primary care health centre.Participants. We studied 875 patients(average age, 55.6 years, with 57.4% women)without evidence of cardiovascular disease,cared for in an urban primary health centre.Measurements and main results. Glomerularfiltration was estimated using Cockcroft-Gault and simplified MDRD equations.Hidden renal failure was considered if theglomerular filtration was <60 mL/min witha normal serum creatinine concentration.Using the Cockcroft-Gault equation 11.2%of study population had hidden renal failureand 12% when using MDRD, and 16.3%of patients with hidden renal failure usingCockcroft-Gault equation had coronaryevents. The relative risk in this groupwas 1.8 (95% confidence interval [CI],1.1-2.9; P<.05). The percentage ofcoronary events was 16.2% when glomerularfiltration was estimated by MDRD (relativerisk, 1.9; 95% CI, 1.2-3.1; P<.05). Binarylogistic regression analysis showed that age,male sex, smoking, diabetes, and diastolicpressure were the predicting variables ofcardiovascular events, the highest odds ratiocorresponding to the smoking population.The presence of hidden renal failure wasnot statistically significant using eitherCockcroft (odds ratio, 1.21; 95% CI, 0.64-2.28; P=.566) or MDRD (odds ratio, 1.64;95% CI, 0.77-3.48; P=.200)Conclusions. The prevalence of occult renaldysfunction in the 35-74 years populationis high, but it does not behave as anindependent cardiovascular risk factor