The most important prognostic factors for predicting major adverse cardiovascular, cerebrovascular, and renal events during 5-year follow-up of patients with chronic kidney disease with or without haemodialysis

OBJECTIVE: Patients with chronic kidney disease (CKD) have an increased risk of adverse cardio-cerebrovascular events. The purpose of this study is to evaluate the prognostic predictors over 5 years in patients with CKD including haemodialysis. METHODS: In this multicenter, prospective cohort study performed with the Gunma-CKD SPECT Study protocol, 311 patients with CKD [estimated glomerular filtration rate (eGFR) < 60 min/ml/1.73 m 2 ], including 50 patients on haemodialysis, undergoing stress Tc-99m-tetrofosmin SPECT for suspected ischaemic heart disease were followed for 5 years. MACCRE was evaluated, and summed stress score, summed rest score, summed difference score (SDS), left ventricular end-diastolic volume (LVEDV), end-systolic volume (LVESV) and ejection fraction (LVEF) were evaluated by electrocardiogram-gated SPECT. RESULTS: Of the 311 patients, 268 were followed for 5 years, and of those patients, 126 experienced MACCRE: cardiac death, n = 15; sudden death, n = 5, nonfatal myocardial infarction, n = 5; hospitalization for heart failure, n = 16; cerebrovascular accident, n = 9; revascularization, n = 49; renal events (haemodialysis initiation/kidney transplantation), n = 20 and other cardiovascular events, n = 7. In univariate Cox analysis, eGFR ( P < 0.0001), haemoglobin ( P = 0.001), SDS ( P = 0.0001), LVEDV ( P = 0.002), LVESV ( P = 0.0003) and LVEF ( P < 0.0001) were associated with MACCRE, and in multivariate Cox analysis, eGFR ( P = 0.014) and SDS ( P = 0.002) were strongly associated with MACCRE. In Kaplan-Meier analysis, the event-free survival rate for MACCRE was better in patients with SDS below 3 than in those with SDS of 3 or higher ( P < 0.0001, log-rank test) and in patients with eGFR of 18 or higher than in those with eGFR below 18 ( P < 0.0001, log-rank test). CONCLUSION: In patients with CKD, SDS and eGFR are reliable prognostic markers for the occurrence of MACCRE over 5 years.