Cardiovascular Risk Across Different Glomerular Diseases

BACKGROUND: It was well-established that patients with glomerulonephritis face an elevated cardiovascular risk, yet little was known about the differential impacts of various etiologies of glomerular disease on cardiovascular outcomes. In this large cohort study encompassing patients with distinct forms of glomerular nephritis, we aimed to compare the effects of different etiologies on cardiovascular death events. METHODS: Utilizing data from the China Renal Data System (CRDS) database, we identified 66,247 patients with glomerulonephritis across 14 distinct etiologies between 2000 and 2022. The risks of cardiovascular death, ischemic heart disease associated death, and stroke associated death among different types of patients were compared. RESULTS: Within a cohort of 66,247 patients with glomerulonephritis, immunoglobulin A (IgA) nephropathy (39%) was the most prevalent etiology, followed by lupus nephritis (17%) and membranous nephropathy (16%). During follow-up, 971 cardiovascular deaths (1%), 337 ischemic heart associated deaths (0.5%), and 286 stroke associated deaths (0.4%) were recorded. The overall crude cardiovascular death rates across glomerulonephritis subtypes ranged from 0.7 to 22.6 per 1,000 person-years. All patients with glomerular diseases demonstrated elevated cardiovascular death risks compared to the general population, with lupus nephritis exhibiting the highest risk (indirect standardized mortality ratio of 27.89) and minimal change disease the lowest (indirect standardized mortality ratio of 3.91). Furthermore, when compared directly to patients with minimal change disease, all other glomerulonephritis subtypes were associated with significantly greater cardiovascular death risk. CONCLUSIONS: Patients with different underlying glomerular diseases exhibited markedly heterogeneous and elevated cardiovascular risk profiles.