A study led by Peter McCullough, M.D. of Beaumont Hospital,
published in the June 11 issue of Archives of Internal Medicine, found
three markers of chronic kidney disease related to the risk of heart disease.
Furthermore, findings from another study, also part of the Kidney Early
Evaluation Program, demonstrated heart disease is associated with subsequent
kidney function decline and development of kidney disease.
"Many doctors are not aware that chronic kidney disease
promotes and accelerates heart disease at a rapid rate," says Dr.
McCullough, one of the authors of the national studies and chief, division of
Preventive Medicine, Beaumont, Royal Oak. "And because kidney disease
often is silent until dialysis is needed, those at risk need to have their
blood sugar, blood pressure and cholesterol monitored on a monthly basis."
Chronic kidney disease is becoming increasingly prevalent in
the United States
and worldwide. It is associated with a wide variety of complications, including
anemia (low red blood cell count, or red blood cells that are deficient in
oxygen-transporting hemoglobin), nerve pain, bone disease, death and
cardiovascular disease. Most patients with chronic kidney disease die of
complications from heart disease rather than of kidney failure.
Dr. McCullough and his colleagues assessed a group of 37,153
individuals who were screened for kidney disease through a community-based
program between 2000 and 2003. The participants (average age of 52.9 years) all
reported a personal or family history of diabetes, hypertension or kidney
disease on a screening survey. Patients had their blood pressure measured and
provided blood and urine samples, which were processed to assess three markers
of chronic kidney disease:
rate at which kidneys filter blood, calculated based on levels of the
waste product creatinine in the blood, also known as eGFR
determined by blood hemoglobin levels
high levels of the protein albumin in the urine or microalbuminuria
Of the participants who were followed for a maximum of 47.5
months, 5,504 (14.8 percent) had eGFRs considered abnormal and signs of
declining kidney function. In addition, 4,588 (13.1 percent) had anemia; and
15,959 (49.5 percent) had microalbuminuria. A total of 1,835 (4.9 percent) had
a history of heart attack, 1,336 (3.6 percent) had a history of stroke and
2,897 (7.8 percent) had a self-reported history of heart attack or stroke.
Each of the three markers was associated with cardiovascular
disease. More than one-fourth of the patients who had all three kidney disease
measures had cardiovascular disease, and their survival rates over the course
of the study were lower by approximately 93 percent than those of any other
The data suggest that screening for cardiovascular disease
would be beneficial among patients with these risk markers but who do not
report any history of cardiovascular disease symptoms.
"Because these patients are mainly under the care of
primary care physicians and cardiologists, it is important to draw attention to
the increased risk of kidney disease in this population, with goals of
preventing further progression, managing kidney disease as they arise and
adequately preparing individuals for kidney failure with timely nephrology
referrals," say the authors. "Only with recognition of risk factors
for kidney disease can this happen."