A29(Th)
Stringer, S 1,2,4 , Dutton, M 1,4 , Ferro, C 1,2,4 , Jain, P 3,4 , Andujar, C 1,4 , Waite, C 1,4 , Kaur, O 1,2,4 ,
Cockwell, P 1,2,4
1 Department of Nephrology, University Hospital Birmingham, 2 School of Immunity and
Infection, University of Birmingham, 3 School of Primary Care, University of Birmingham,
4 Renal Institute of Birmingham
INTRODUCTION: Chronic Kidney Disease (CKD) affects around 10% of adults in the UK. Those at highest risk of early death and/or established renal failure (ERF) requiring dialysis have progressive
CKD or a risk of progressive CKD as defined by a sequential decline in eGFR and/or the presence of proteinuria.
The RIISC ( R enal I mpairment I n S econdary C are) study is a recently commenced large prospective cohort study which aims to enrol at least 1000 people at highest risk from CKD. The study utilises robust protocols and state of the art non-invasive assessments to address a number of research questions around the natural history of progressive CKD. Here we report the incident CV phenotype of all those recruited into the study to date.
METHOD: Patients fulfilled the following criteria for enrolment: (i) progressive CKD (eGFR fall of
5mls/min/year or 10mls/min /5years) and/or (ii) an ACR >70 mg/mmol on 2 consecutive occasions,
All patients must have an eGFR at screening of 15-60 mls/min/1.73m
2 , People with a renal disease requiring or likely to require immune modulating drugs were excluded from recruitment. All patients underwent a de Those patients recruited undergo a detailed bio-clinical assessment including CV assessment which included a detailed history, validated BP by BpTRU (equivalent to daytime
ABPM), pulse wave velocity (PWV) and analysis by Vicorder, and measurement of glycation end products using an AGE reader, these measurements were taken at a temperature that was maintained between 22-24°C. Periodontal assessment was also performed (by dentists and hygienists) and serum, urine and saliva collection for bio-marker measurement.
RESULTS: At time of submission of this abstract 40 patients had been recruited. The mean age was
59.7 years (22-88) and 63% were men. 68% were of white ethnicity, 18% black and 10% south
Asian. The mean eGFR at enrolment was 24mls/min (7-34). 27.5% had a previous diagnosis of CV disease (ischaemic heart disease, cerebrovascular disease and peripheral vascular disease combined) and 45% of the cohort patients had diabetes (20% had both CVD and diabetes). The mean PWV was
9.74 m/s (7.406-12.084); with no relationship between PWV and eGFR (p = 0.2, r= 0.2) or between either the presence of CV disease or diabetes and PWV (p = 0.5, p= 0.4, r= 0.780 and r = 0.56 respectively). AGE readings were obtained in 77% (skin pigmentation precluded assessment in some black and south-Asian subjects). The mean reading was 3 AU (1.6-6.2). There was no relationship between AGE readings and the presence of CV disease (p = 0.4, r = 0.2) or AGE readings and diabetes (p = 0.236, r = 0.4)
CONCLUSIONS: The RIISC cohort has a high incidence of CV disease and diabetes however none of the end points have been reached. There are early incident associations between routinely measured data and non-invasive vascular assessments; however these are not statistically significant as yet.