Article Text

other Versions

Download PDFPDF
Extended report
Subclinical renal dysfunction is independently associated with cardiovascular events in rheumatoid arthritis: the CARRÉ Study
  1. A M van Sijl1,2,3,
  2. I A M van den Oever1,
  3. M J L Peters3,
  4. M Boers1,4,
  5. B A C Dijkmans1,2,5,
  6. V P van Halm6,
  7. Y M Smulders3,5,
  8. A E Voskuyl2,
  9. M T Nurmohamed1,2,3
  1. 1Department of Rheumatology, Jan van Breemen Research Institute/Reade, Amsterdam, The Netherlands
  2. 2Department of Rheumatology, VU University Medical Centre, Amsterdam, The Netherlands
  3. 3Department of Internal Medicine and Institute for Cardiovascular Research (ICaR), VU University Medical centre, Amsterdam, The Netherlands
  4. 4Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands
  5. 5Rheumatology, Free University Hospital, Amsterdam, The Netherlands
  6. 6Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands
  1. Correspondence to Dr M T Nurmohamed, Departments of Internal Medicine and Rheumatology, VU University Medical Centre, PO Box 7057, 1007 MB Amsterdam, The Netherlands; mt.nurmohamed{at}


Background Patients with rheumatoid arthritis (RA) have double the risk of cardiovascular (CV) disease, largely independently of traditional CV risk factors. Renal dysfunction is associated with CV morbidity and mortality in the general population, but data on this association in RA are lacking.

Objective To investigate the association between renal function and CV events in RA.

Methods The CARRÉ Study is an ongoing prospective cohort study of Dutch patients with RA, which records CV events. Glomerular filtration rate (GFR) was estimated with the abbreviated Modification of Diet in Renal Disease formula. Logistic regression determined the association between estimated GFR and the occurrence of CV events.

Results 353 patients were followed for 3 years, and 23 (7%) had a CV event. Patients who had an event had a significantly lower baseline GFR than those who did not (59 vs 79 ml/min, p=0.001). This association remained significant after adjustment for traditional risk factors: in this analysis, a decrease in GFR of 5 ml/min was associated with a 30% (95% CI 7% to 59%) increase in the occurrence of CV events. During follow-up, an unfavourable change in GFR was noted in patients who later had a CV event compared with those who did not.

Conclusion These data confirm that, in RA, renal dysfunction is associated with a higher risk of CV disease independently of traditional CV risk factors.

Statistics from


  • Patient consent Obtained.

  • Ethics approval Ethics Committee of the Slotervaart Hospital and Read.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.