Renal function as a risk indicator for cardiovascular events in 3216 patients with manifest arterial disease

Aim To establish whether impaired renal function is an independent predictor of cardiovascular disease (CVD) and death in an unselected high-risk population with CVD. Methods and results In 3216 patients with CVD, the estimated glomerular filtration rate (GFR) was assessed with the Modification of Diet in Renal Disease (MDRD)-equation. Primary outcomes were all vascular events (including stroke, myocardial infarction, end-stage renal disease and vascular death) and all cause death. During a median follow-up of 39 months, 378 patients had a vascular event (11.7%) and 337 patients died (10.5%). The adjusted hazard ratio (HR) of an estimated GFR ≤ 60 versus >90 ml/min per 1.73 m2 was 1.8 (95% CI, 1.2–2.6) for vascular events and 1.4 (95% CI 0.9–2.0) for all cause death. For stroke and cardiac events as separate outcomes, similar HRʹs were found. Subgroup analysis according to localization of vascular disease at presentation or presence of the risk factors hypertension, diabetes and albuminuria had no influence on the hazard ratios. Conclusions The presence of moderate to severe renal insufficiency is an independent risk factor for adverse CVD events in high-risk patients with a history of vascular disease. Localization of vascular disease or presence of other risk factors had no influence on the impact of renal function alone.