Cardiovascular and renal outcomes according to KDIGO stages of chronic kidney disease in the Spanish population: Insights from real-world evidence

Abstract

OBJECTIVE: Real-world analysis of the clinical profile, treatments, major adverse cardiovascular and renal events (MACE and MARE) in patients with different stages of chronic kidney disease (CKD) as defined by KDIGO guidelines. METHODS: This was an observational, retrospective study using the BIG-PAC database. Adults with ?1 measurement of estimated glomerular filtration rate (eGFR) and albumin-to-creatinine ratio (UACR) closest to 1st January 2018 (up to 6 months) were included. Patients were followed for two years. RESULTS: Among 70,385 subjects, 21,127 (30.0%) had CKD based on impaired renal function or increased albuminuria. Age and prevalence of diabetes and cardiovascular disease increased as kidney function decreased, or albuminuria rose. Renin-angiotensin system inhibitors were prescribed in 47.1-76.4% patients classified as G3a-G5 and mildly increased albuminuria (A1), 63.2-79.6% in G1-G5 and moderately increased albuminuria (A2), and 51.2-85.9% in G1-G5 and severely increased albuminuria (A3). The prescription of sodium-glucose cotransporter-2 inhibitors was marginal across KDIGO categories. The incidence rates (per 1000 patient-year) of MACE ranged 102.9-245.2 in patients classified as G3a-G5 A1, 40.7-261.1 in G1-G5 A2, and 69.1-362.3 in G1-G5 A3. Incidence rates of MARE ranged 14.9-454.4 in G3a-G5 A1, 29.8-588.5 in G1-5 A2, and 11.8-637.2 in G1-5 A3. CONCLUSIONS: In real-world, the risk of cardiovascular and renal complications rises as kidney function declines and albuminuria worsens. Guideline-recommended therapies remain underused.