NEW YORK (Reuters Health) - Renal disease need not be severe to cause considerable morbidity and mortality, according to the findings from two studies published in The New England Journal of Medicine for September 23. Both reports "reinforce the importance of early detection of chronic kidney disease, not only to slow the progression to end-stage renal disease but also in this case to identify risk factors for cardiovascular disease," notes an editorialist.

In one study, Dr. Marc A. Pfeffer, from Brigham and Women's Hospital in Boston, and colleagues assessed the effect of mild renal disease on cardiovascular outcomes after MI by analyzing data from 14,527 patients enrolled in the Valsartan in Acute Myocardial Infarction Trial (VALIANT).

Compared with other subjects, those with a reduced estimated glomerular filtration rate were more likely to have co-existing risk factors, prior cardiovascular disease, and a Killip class of II or higher. Also, such subjects were less likely to use beta-blockers, aspirin, and statins and to undergo coronary revascularization.

The estimated GFR was inversely related to the risk of death as well as the combined outcome of death from cardiovascular causes, congestive heart failure, reinfarction, stroke, or resuscitation after cardiac arrest.

Most of the morbidity seen with a falling GFR was not renal in nature, but cardiovascular. Each drop of the GFR by 10 units below 81 mL/minute/1.73 mm², increased the risk of death and nonfatal cardiovascular events by 10%.

In the other study, Dr. Alan S. Go, from Kaiser Permanente of Northern California in Oakland, and colleagues assessed the impact of mild kidney disease among more than 1 million adults entered in the Kaiser Permanente Renal Registry. The median follow-up period was 2.84 years.

The team found that the risk of death increased as the GFR dropped. A mildly decreased GFR raised the risk of death by 20%, whereas a severely low GFR (less than 15 mL/minute/1.73 mm²) increased the risk nearly six-fold. The risk of cardiovascular events and hospitalization also rose as the GFR fell.

These studies, which used "quite different populations," strengthen "the epidemiologic link between chronic kidney disease and cardiovascular disease," Dr. Thomas H. Hostetter, from the National Institutes of Health in Bethesda, Maryland, states in his editorial.

N Engl J Med 2004;351:1344-1346

N Engl J Med 2004;351:1285-1295

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