CKD Associated With Abdominal Aortic Aneurysm

Abdominal aortic aneurysms (AAAs) were found to develop more frequently in patients with chronic kidney disease (CKD), according to a study published in Annals of Surgical Treatment and Research. The findings demonstrated that risk increased as the stage of CKD advanced.

AAAs are defined as segmental, full-thickness dilations of the aorta that result in a 50% increase in the diameter compared with the diameter of a normal aorta, and they can be fatal if they rupture. CKD is known to be a strong predictor of impaired all-cause survival and affects approximately 10% to 20% of adults. The current study aimed to determine if advanced stage of CKD was a risk factor for the development of AAA by using nationwide population cohort data from Korea.

The National Health Insurance Service (NHIS), which consists of 2 major health care programs for all residents of Korea, was used to collect data for this study. All resident registration numbers were encrypted for anonymity.

Data for residents of Korea aged 19 years or older who received at least 1 checkup provided by NHIS between January 2009 and December 2009 were evaluated. Patients who had a diagnosis of AAA prior to the health care checkup and within a year of the index date were excluded. Patients with missing data and who did not receive a checkup in the prior 2 years were excluded.

There were 9,938,329 participants included in this study, all of whom were separated into 4 groups based on their stage of CKD: stage 1 (41.1%), stage 2 (46.6%), stage 3 (11.9%), and stage 4 and greater (0.4%). Advanced stage of CKD was associated with age, glucose, and other comorbidities, such as diabetes and hypertension. Patients in the advanced stage of CKD had lower body mass index (BMI), waist circumference, and rates of current smoking and drinking.

A total of 20,760 participants developed AAA during the median (IQR) follow-up of 9.3 (9.1-9.6) years. Participants with CKD in stages 1, 2, 3, and 4 or 5 had an incidence rate of 0.10, 0.23, 0.67, and 1.19 for AAA, respectively, with a Kaplan-Meier curve finding that AAA incidence rate increased proportionally to stage of CKD.

Risk of AAA development was associated with a more advanced stage of CKD, with an unadjusted HR of 2.414 (95% CI, 2.32-2.51), 7.06 (95% CI, 6.78-7.35), and 12.94 (95% CI, 11.59-14.45) for CKD stages 2, 3, and 4 or 5, respectively, when compared with stage 1 of CKD.

Risk of AAA was increased in stages 4 and 5 of CKD compared with stage 1 when adjusting for stroke, diabetes, hypertension, hyperlipidemia, chronic obstructive pulmonary disease, BMI, and urine protein (HR, 1.30; 95% CI, 1.15-1.46).

A subgroup analysis was performed, with participants split into 3 groups: CKD stage 1, CKD stage 2, and CKD stages 3, 4 and 5. Increased risk of AAA was found anibg participants in the staged 3, 4, and 5 group who were male, younger than 65 years, ex-smokers, or currently smoking compared with their counterparts.

There were some limitations to this study. Selection bias may have been involved given the retrospective design of the study, given most patients receiving regular medical examinations are usually healthier. The study was based on insurance claims for AAA, which might not be able to accurately represent the specific disease status of the participants. The study cohort also consisted entirely of Korean participants, which may limit generalizability.

The researchers concluded that CKD was associated with an increased risk of AAA, with the risk increasing at more advanced stages of CKD.

Reference

Jun KW, Yoo JH, Ko KJ, et al. Chronic kidney disease as a risk factor for abdominal aortic aneurysm: a nationwide population-based study. Ann Surg Treat Res. 2022;103(5):297-305. doi:10.4174/astr.2022.103.5.297