Subclinical eGFR associated with cardiovascular disease in younger patients

A retrospective cohort study in Canada found that the relative risk for major cardiovascular events with or without heart failure increased in adults ages 18 to 39 years with an eGFR below 80 mL/min/1.73 m2.

Lower estimated glomerular filtration rate (eGFRs) may indicate higher risk for cardiovascular disease in younger patients, a recent study found.

Researchers conducted a retrospective cohort study using health care data sets from Ontario, Canada, to examine age-specific associations between subclinical eGFR reductions in young adults and major adverse cardiovascular events (MACE) and MACE plus heart failure. MACE was defined as cardiovascular mortality, acute coronary syndrome, and ischemic stroke. Results were published Sept. 18 by the Journal of the American College of Cardiology.

Overall, 8.7 million people (3.6 million ages 18 to 39 years) were included in the study from January 2008 to March 2021. The mean age was 41.3 years, mean eGFR was 104.2 mL/min/1.73 m2, and median follow-up was 9.2 years. The relative risk for MACE and MACE plus heart failure increased in young adults with an eGFR below 80 mL/min/1.73 m2, the study found. Hazard ratios at an eGFR of 70 to 79 mL/min/1.73 m2 were 1.31 (95% CI, 1.27 to 1.40) for patients ages 18 to 30 years, 1.09 (95% CI, 1.06 to 1.12) for those ages 40 to 49 years, and 1.07 (95% CI, 1.05 to 1.08) for those ages 50 to 65 years. The association persisted for each MACE component and in additional analyses that stratified patients according to past cardiovascular disease, accounted for index albuminuria, and used repeated measures of eGFR.

“In this population-based cohort of 8.7 million community-dwelling adults, we found that subclinical eGFR declines (ie, eGFR above the current [chronic kidney disease] definition but below age-expected values) were associated with a higher risk of MACE and [MACE plus heart failure] relative to age-specific referents,” the authors wrote. “Moreover, this risk elevation occurred at higher eGFR thresholds in adults aged 18 to 39 years compared with those aged ≥40 years.” They called for age-appropriate risk stratification, proactive monitoring, and timely intervention in this age group.

An editorial accompanying the study said that measuring eGFR and albuminuria at least every five years in young and middle-aged adults could be useful for disease prevention.

“[S]trategic health programs considering integrative aspects of socioeconomic factors and multiple disease conditions should be developed and implemented to promote and expand access to kidney screening and clinical care, ultimately reducing the burden of severe kidney disease, [cardiovascular disease], and mortality,” the editorialists concluded.