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Overall Burden and Rates of Treatment and Control

Nisha I. Parikh, MD, MPH; Shih-Jen Hwang, PhD; Martin G. Larson, ScD; James B. Meigs, MD, MPH; Daniel Levy, MD; Caroline S. Fox, MD, MPH

Arch Intern Med. 2006;166:1884-1891.

Background  Mild to moderate chronic kidney disease (CKD) is associated with increased risk for cardiovascular disease. The burden of cardiovascular disease risk factors in this setting is not well described.

Methods  We compared the age- and sex-adjusted prevalence of cardiovascular disease risk factors and their treatment and control among persons with and without CKD in 3258 Framingham offspring cohort members who attended the seventh examination cycle (1998-2001). Glomerular filtration rate (GFR) was estimated using the simplified Modification of Diet in Renal Disease Study equation. We defined CKD as a GFR of less than 59 mL/min per 1.73 m² in women and less than 64 mL/min per 1.73 m² in men.

Results  Those with CKD were older, more likely to be obese (33.5% vs 29.3%; P=.02), and more likely to have low levels of high-density lipoprotein cholesterol (45.2% vs 29.4%; P<.001) and high triglyceride levels (39.9% vs 29.8%; P<.001). Those with CKD had a higher prevalence of hypertension (71.2% vs 42.7%; P<.001) and hypertension treatment (86.0% vs 72.5%; P<.001), but were less likely to achieve optimal blood pressure control (27.0% vs 45.5%; P<.001). Participants with CKD had a higher prevalence of elevated low-density lipoprotein cholesterol levels (60.5% vs 44.7%; P=.06) and lipid-lowering therapy (57.1% vs 42.6%; P=.09), although this was not statistically significant. A greater proportion of individuals with CKD than those without had diabetes (23.5% vs 11.9%; P=.02) and were receiving diabetes treatment (63.6% vs 46.9%; P=.05), but were less likely to achieve a hemoglobin A_1c level of less than 7% (43.8% vs 59.4%; P=.03).

Conclusions  Chronic kidney disease is associated with a significant burden of cardiovascular disease risk factors in the community. The diagnosis of CKD should alert the practitioner to look for potentially modifiable cardiovascular risk factors.

Author Affiliations: National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Mass (Drs Parikh, Hwang, Larson, Levy, and Fox); General Medicine Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School (Dr Meigs), Department of Mathematics and Statistics, Boston University (Dr Larson), and Department of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School (Dr Fox), Boston, and National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Md (Drs Hwang, Levy, and Fox).

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