Americans on dialysis more likely to develop CVD than their Japanese counterparts

Researchers have found in a new study that Americans on dialysis more likely to develop CVD than their Japanese counterparts. The study by Takahiro Imaizumi suggests that higher Left Ventricle (LV) mass and lower ejection fraction (EF) in patients with chronic kidney disease (CKD), even in the normal range, are predictive of cardiovascular disease (CVD).

The findings of the study were published in Kidney International Journal.

This study aimed to compare outcomes in patients with predialysis CKD between the United States and Japan and determine potential mediators of any differences. The study analyzed data from two cohort studies, the Chronic Renal Insufficiency Cohort (CRIC) in the United States and the CKD Japan Cohort (CKD-JAC) in Japan.

The results showed that, on average, patients in the CRIC cohort had higher body mass index (BMI), lower left ventricular EF, and higher levels of C-reactive protein (CRP) than patients in the CKD-JAC cohort. Low EF and high left ventricular mass index (LVMI) were significantly associated with subsequent CVD in both cohorts.

During a median follow-up of five years, the CRIC participants had a significantly higher risk for CVD and death compared to the CKD-JAC participants. The differences in CRP and phosphate levels between the two cohorts partially mediated the difference in CVD risk, but echocardiographic parameters (LVMI and EF) were stronger mediators of the differences.

The study also suggests that differences in BMI, CRP, and phosphate levels may contribute to the higher risk of CVD in patients with predialysis CKD in the United States compared to Japan, but these differences are not the sole mediators of the observed differences in CVD risk. The findings of this study could inform the development of interventions to reduce CVD risk in patients with CKD.

Reference:

Imaizumi, T., Fujii, N., Hamano, T., Yang, W., Taguri, M., Kansal, M., Mehta, R., Shafi, T., Taliercio, J., Go, A., Rao, P., Hamm, L. L., Deo, R., Maruyama, S., Cohen, D. L., … Unruh, M. L. (2023). Excess risk of cardiovascular events in patients in the United States vs. Japan with chronic kidney disease is mediated mainly by left ventricular structure and function. In Kidney International. Elsevier BV. https://doi.org/10.1016/j.kint.2023.01.008