PubMed ID:
35610408
Public Release Type:
Journal
Publication Year: 2022
Affiliation: 1Division of Rheumatology, University of Washington, Seattle, WA
2Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, Washington
3Department of Internal Medicine, University of Connecticut, Farmington, Connecticut
4 Rheumatology Section, Medicine Service Line, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA and Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
5 Division of Rheumatology, Howard University Hospital, Washington, DC
6 Division of Nephrology, University of Iowa Hospitals and Clinics, Iowa, IA
7Section of Rheumatology, Boston University School of Medicine, Boston, MA
DOI:
https://doi.org/10.1007/s10067-022-06223-x
Authors:
Alexander S,
Prince DK,
Jalal D,
Namrata Singh N,
Kerr GS,
Richards JS,
Bansal N,
Liew JW,
Ezeanuna MN
Request IDs:
22781
Studies:
Chronic Renal Insufficiency Cohort Study
Background: Rheumatoid arthritis (RA) is associated with an increased risk of cardiovascular disease. RA is also associated with an increased risk of chronic kidney disease (CKD), a known cardiovascular risk factor. We hypothesized that among a cohort of patients with CKD, RA would be associated with an increased risk of mortality. Materials and Methods: We conducted this retrospective study using participants from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Prospective Chronic Renal Insufficiency Cohort (CRIC) study. Approximately 3700 participants, ages 21 – 74 years with mild to moderate CKD, were enrolled from seven US clinical centers. The primary outcome of interest was all-cause mortality. Secondary outcomes included: CKD progression defined as end stage kidney disease or 50% decline in estimated glomerular filtration rate, myocardial infarction, cerebrovascular accident, heart failure and a composite cardiovascular endpoint. The association of RA with mortality over time was examined using multivariable Cox proportional hazards regression, adjusting for potential confounders (age, sex, race/ethnicity, body mass index, current smoker, and education). Results: The study cohort included 83 participants with RA on a disease modifying anti-rheumatic drug (DMARDs), with mean follow-up 9.5 years. In the adjusted analysis, CKD- RA status remained significantly associated with increased risk of death even after adjusting for traditional risk factors [adjusted HR 1.73 (1.27, 2.35)]. Similar statistically significant associations were observed between RA status and other secondary outcomes except for CKD progression. Conclusion: RA was associated with higher mortality among individuals with CKD but not progressive renal decline. Further studies evaluating the mechanisms behind this association are needed.