Kidney Function, Kidney Function Decline, and the Risk of Abdominal Aortic Aneurysm: The Stockholm CREAtinine Measurements (SCREAM) Project

European Journal of Vascular and Endovascular Surgery, vol. 69, pp. 601–608

Abstract

Objective Low estimated glomerular filtration rate (eGFR) increases the risk of arterial diseases, possibly including abdominal aortic aneurysm (AAA). This study explored the relationship between eGFR (2008 CKD-EPI equation), annual eGFR decline, and subsequent risk of developing AAA in a large, community based sample. Methods This was an observational study using complete healthcare records of Stockholm residents free from AAA who underwent routine creatinine testing during 2011 – 2021. Cox regression, adjusted for age, sex, comorbidities, and ongoing medications, was used to analyse the association between a single point eGFR or the change in eGFR within a year and the rate of both a de novo AAA diagnosis (both intact and ruptured) and fatal AAA (i.e., AAA followed by death within 30 days). Results The study included 1 586 410 participants (mean age 48 years; 53% female; median eGFR 96 mL/min/1.73 m 2 ). During a median follow up of 7.6 years, 5 313 participants (0.34%) experienced AAA, of which 321 (0.02%) were fatal. In multivariable analyses, compared with eGFR 90 mL/min/1.73 m 2 , the rates of AAA events were higher across lower eGFRs: for eGFR 30 mL/min/1.73 m 2 , the hazard ratio (HR) of AAA was 1.24 (95% confidence interval [CI] 1.09 – 1.40) and of fatal AAA was 2.51 (95% CI 1.67 – 3.75); for eGFR 15 mL/min/1.73 m 2 , the HR of AAA was 1.49 (95% CI 1.19 – 1.86) and of fatal AAA was 3.73 (95% CI 2.04 – 6.81). When analysed separately, the results were similar for intact and ruptured AAA risk. Among the 638 959 participants who had repeated eGFR tests, 3 447 (0.54%) experienced AAA events, of which 217 (0.04%) were fatal. Compared with stable eGFR (change –1 to 1 mL/min/year), the rate of AAA events was 15% higher (HR 1.15, 95% CI 1.05 – 1.26) in participants with an eGFR decline of 1 to 3 mL/min/year and 46% higher (HR 1.46, 95% CI 1.16 – 1.84) in those with an eGFR decline of > 3 mL/min/year. Conclusion In this observational study, both a single point eGFR and a faster eGFR decline were associated with the risk of experiencing AAA. The incidence of AAA, and particularly fatal AAA, was higher in individuals with greater severity of chronic kidney disease or faster eGFR decline.

Authors 8

1. Shigeru Tanaka

   Kyushu University · Karolinska Institutet

   Affiliation as printed

   Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

2. Alessandro Bosi

   Karolinska Institutet

   Affiliation as printed

   Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

3. Edouard L. Fu Aachen

   Leiden University · Leiden University Medical Center · Karolinska Institutet

   Affiliation as printed

   Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands

   Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands

4. Kunitoshi Iseki
   Affiliation as printed

   Nakamura Clinic, Urasoe, Japan

5. Takanari Kitazono

   Kyushu University

   Affiliation as printed

   Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

6. Rebecka Hultgren

   Karolinska University Hospital · Karolinska Institutet

   Affiliation as printed

   Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden

7. Anne‐Laure Faucon

   Karolinska Institutet

   Affiliation as printed

   Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

8. Juan Jesús Carrero corresponding

   Danderyds sjukhus · Karolinska Institutet

   Affiliation as printed

   Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden. Electronic address: juan.jesus.carrero@ki.se