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Urea levels and cardiovascular disease in patients with chronic kidney disease.


ABSTRACT:

Background

Elevated serum urea levels are common in moderate-to-advanced CKD. Several studies have shown that urea is a direct and indirect uremic toxin, especially with regard to cardiovascular disease. We sought to determine whether serum urea levels are associated with adverse cardiovascular events and death before renal replacement therapy (RRT) in patients with CKD.

Methods

CKD-REIN is a prospective cohort of CKD nephrology outpatients not receiving maintenance dialysis. The 2507 patients included in the analysis were divided into three groups according to the baseline serum urea level (T1 < 10.5, T2:10.5 to 15.1, and T3 ≥ 15.1 mmol/L). Cox proportional hazard models were used to estimate hazard ratios (HRs) for first atheromatous or nonatheromatous cardiovascular (CV) events, and all-cause mortality before RRT. The models were adjusted for baseline comorbidities, laboratory data, and medications.

Findings

Of the 2507 included patients (median [interquartile range (IQR)] age: 69[61-77]; mean (standard deviation) eGFR 33.5(11.6) mL/min/1.73 m²), 54% had a history of cardiovascular disease. After multiple adjustments for cardiovascular risk factors (including eGFR), patients in T3 had a higher risk of atheromatous and nonatheromatous cardiovascular events than patient in T1 (n events = 451, HR[95%CI]: 1.93[1.39-2.69]). The adjusted HRs for death before RRT (n events = 407) were 1.31[0.97; 1.76] and 1.73[1.22; 2.45] for patients T2 and those in T3, respectively.

Interpretation

Our data suggested that urea is a predictor of cardiovascular outcomes beyond CV risk factors including eGFR.

SUBMITTER: Laville SM 

PROVIDER: S-EPMC9869852 | biostudies-literature | 2022 Feb

REPOSITORIES: biostudies-literature

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Publications

Urea levels and cardiovascular disease in patients with chronic kidney disease.

Laville Solène M SM   Couturier Aymeric A   Lambert Oriane O   Metzger Marie M   Mansencal Nicolas N   Jacquelinet Christian C   Laville Maurice M   Frimat Luc L   Fouque Denis D   Combe Christian C   Robinson Bruce M BM   Stengel Bénédicte B   Liabeuf Sophie S   Massy Ziad A ZA  

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association 20220226


<h4>Background</h4>Elevated serum urea levels are common in moderate-to-advanced CKD. Several studies have shown that urea is a direct and indirect uremic toxin, especially with regard to cardiovascular disease. We sought to determine whether serum urea levels are associated with adverse cardiovascular events and death before renal replacement therapy (RRT) in patients with CKD.<h4>Methods</h4>CKD-REIN is a prospective cohort of CKD nephrology outpatients not receiving maintenance dialysis. The  ...[more]

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