Renal function and cardiovascular events in predialysis care.

Cardiovascular events (CVE) are highly prevalent in chronic kidney disease (CKD), with risk increasing as CKD progresses. Whether renal function remains associated with CVE in advanced CKD is uncertain. We evaluated the association between CVE and renal function in a prospective observational cohort of predialysis patients (GFR < 30 ml/min). Renal function was measured using plasma-clearance of iohexol (mGFR) and estimated (eGFR) by four equations (CKD-EPI creatinine, MDRD, CKD-EPI cystatin, CKD-EPI-Creatinine-cystatin). Associations were analysed with logistic regression models adjusted for traditional and CKD-specific risk factors. Between 2016 and 2022, 389 patients were included. Median follow-up was 19 months [IQR9-45]. 118 patients (30%) experienced CVE, 18 fatal cases. Mean age was 65 ± 12.5 years, 65% were male; 70% had BMI > 25 kg/m², 58% diabetes, 53% were current/former smokers, and 30% had prior CVE. Pharmacological management followed guideline-based recommendations. Risk factors for new CVE included age (OR = 1.06), diabetes (OR = 2.53), smoking (OR = 1.7) and previous CVE (OR = 2.89). Renal function, proteinuria, traditional CVE risk factors and CKD-related factors were not associated with CVE. In predialysis patients, the main risk factors for CVE were age, diabetes, smoking and previous CVE. Renal function, proteinuria, traditional and CKD-related risk factors were not associated with CVE, possibly reflecting strict guideline-based treatment. Targeted strategies are required to lessen the CVE burden in predialysis care.