Younger adults aged 18-39 years with subclinical reductions in kidney function below their age-expected estimated glomerular filtration rate (eGFR) — but above the universal 60 mL/min/1.73m2 threshold for chronic kidney disease (CKD) diagnosis – are at increased risk for major adverse cardiovascular events (MACE), investigators reported at Kidney Week 2023 and in the Journal of the American College of Cardiology.
Cardiovascular risk has been increasing among younger adults aged 18 to 39 years in the last 2 decades, Manish M. Sood, MD, of Ottawa Hospital Research Institute in Ontario, Canada, and colleagues noted. A800 Series Online Type Ups
The investigators assessed MACE+ risk over a median 9.2 years among 8.7 million adults in Ontario, Canada, including 3.6 million adults aged 18 to 39 years. MACE+ included cardiovascular mortality, acute coronary syndrome, ischemic stroke, and heart failure. Age-adapted eGFR ranges (in mL/min/1.73m2) that were used as the reference category included eGFR 100-109 for adults aged 18-39 years, eGFR 90-99 for those aged 40 to 49 years, and eGFR 80 to 89 for those aged 50 to 65 years.
MACE+ risk increased as eGFR declined to 80-89 and below for younger adults aged 18-39 years, Dr Sood and colleagues reported. Among individuals with an eGFR of 80-89, the risk was a significant 21% higher for the youngest group compared with those aged 50-65. At an eGFR of 70-79 vs 100-109 (reference), the youngest group had a significant 41% increased risk for MACE+. By comparison, adults aged 40 to 49 and 50 to 65 years had a significant 11% and 8% increased risk for MACE+, respectively, at an eGFR of 70 to 79 compared with their age-adapted reference ranges.
A subset of 746,948 adults had UACR measurements. The youngest group had the highest MACE+ risk at all UACR categories above the 3 mg/mmoL threshold throughout the range of eGFR from 50 to more than 120. At an eGFR of 80-89 and a UACR of 3 to less than 30 mg/mmoL, for example, MACE+ risk doubled for the youngest group compared with the reference.
“Younger adults with subclinical eGFR declines are at a greater risk of new-onset, progressive kidney disease (an important risk factor for CV disease) over their lifetime, which necessitates earlier identification and monitoring of other CV risks,” according to Dr Sood’s team. Their findings support more frequent measurement of eGFR and ACR in younger individuals with subclinical eGFR declines. They acknowledged that eGFR and UACR measurements in this real-world cohort were not taken randomly and may have been based on clinical indications.
Both the Framingham and pooled risk equations for cardiovascular risk incorporate older age as a risk factor. Dr Sood’s team noted that it remains debatable whether age itself strongly influences the risk between eGFR and premature cardiovascular risk.
In an editorial accompanying the journal article, Daniel A. Duprez, MD, and David R. Jacobs Jr, PhD, of the University of Minnesota in Minneapolis, who participated in the CARDIA study, commented: “Our data provide evidence to support that routine screening for eGFR and UAE in people as young as 18 years old with very low or low risk is generally helpful, as it can offer effective early support to young adults who are at risk of future poor clinical outcomes.”
They added that, “The fact that the mediation analyses attenuate the incident CVD risk offers hope that aggressive risk factor reduction would be successful in preventing future CVD, in part by altering the course of CKD progression.”
Sood MM, Hussain J, Canney M, Elliott MJ, Hundemer GL, Tangri N. The association between subclinical reductions in kidney function and major adverse cardiovascular events in young adults: A population-based retrospective cohort study. Presented at: Kidney Week 2023; November 2-5, Philadelphia, Pennsylvania. Abstract TH-PO214.
Hussain J, Imsirovic H, Canney M, et al. Impaired renal function and major cardiovascular events in young adults. J Am Coll Cardiol. 2023 Sep 26;82(13):1316-1327. doi:10.1016/j.jacc.2023.07.012
Duprez DA, Jacobs DR Jr. Time to routinely measure eGFR and albuminuria in young and middle-aged adults. J Am Coll Cardiol. 2023 Sep 26;82(13):1328-1330. doi:10.1016/j.jacc.2023.07.013
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