Socio-economic disparities in the distribution of cardiovascular risk in chronic kidney disease stage 3

Fraser, Simon D.S., Roderick, Paul J., McIntyre, Natasha J., Harris, Scott, McIntyre, Christopher W., Fluck, Richard J. and Taal, Maarten W. (2012) Socio-economic disparities in the distribution of cardiovascular risk in chronic kidney disease stage 3. Nephron, 122 (1-2), 58-65. (doi:10.1159/000348835). (PMID:23548499)

Abstract

Background/Aims: For most people with chronic kidney disease (CKD), cardiovascular disease (CVD) risk exceeds risk of progression to end-stage renal disease. This study aimed to investigate the distribution of cardiovascular risk in CKD stage 3 by socio-economic status (SES; measured by area deprivation and educational attainment) and CKD diagnosis awareness.

Methods: 1,741 patients with CKD 3 recruited from primary-care practices for the Renal Risk in Derby Study were assessed for cardiovascular risk factors. Ten-year cardiovascular risk, estimated using Framingham and QRISK2 risk prediction algorithms in eligible subgroups, was dichotomised at ?20% (a threshold for clinical action in the UK), and compared by SES and awareness of CKD diagnosis using logistic regression.

Results: Patients with lower SES had greater adjusted odd ratios (OR) of smoking, diabetes and previous CVD, but not of central obesity, hypertension, elevated total/high-density-lipoprotein cholesterol ratio or albuminuria. Using Framingham scoring (n = 672), the adjusted OR of having ?20% 10-year risk were 2.87 [95% confidence interval (CI) 1.41-5.84] in the lowest deprivation quintile compared to the highest, 2.52 (95% CI: 1.52-4.00) in those without qualifications compared to those with qualifications, and 1.54 (95% CI: 1.09-2.17) in those unaware of their CKD diagnosis compared to those aware of it. QRISK2 scoring (n = 1,071) showed a similar association with education status [OR: 2.45 (95% CI: 1.63-3.67)] and lack of CKD awareness [OR: 1.46 (95% CI: 1.05-2.03)], but not with deprivation [OR: 1.12 (95% CI: 0.55-2.27)].

Conclusion: An elevated CVD risk is associated with a lower education status and lack of awareness of CKD diagnosis in people with CKD 3.

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Contributors

Author: Simon D.S. Fraser

Author: Paul J. Roderick

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