BACKGROUND: Chronic kidney disease (CKD) represents one of the most significant risks for death, in patients with existed cardiovascular disease (CVD). This study aimed to investigate whether the excess risk of death in these patients could be reduced or eliminated through joint intensive control of blood pressure, glucose and renin-angiotensin system inhibitors (RASi) treatment, among CVD patients with CKD. METHOD: Overall, 6222 CVD patients with CKD and 9274 matched CVD patients who were free of CKD, hypertension and diabetes from CIN II cohort (NCT05050877), were included in the study. The association of all-cause and cardiovascular mortality with guideline-directed management was detected by Cox proportional hazards regression analysis. RESULT: During 5.6-year median follow-up, 3076 (19.9 %) patients died and 1578 (10.2 %) for cardiovascular cause. Among patients with CKD, risk factor controls and treatment were associated with a reduction in the risk of all-cause and cardiovascular mortality. Furthermore, compared to the non-CKD patients, both risk factors within the target ranges plus RASi therapy could theoretically eliminate the excess risk of all-cause (1-year: adjusted hazard radio [aHR] = 0.79, 95 % CI: 0.39-1.63
long-term: aHR = 0.99, 95 % CI: 0.73-1.34) and cardiovascular (1-year: aHR = 1.26, 95 % CI: 0.82-1.93
long-term: aHR = 1.15, 95 % CI: 0.75-1.76) mortality associated with CKD in stage 3a patients. Similar results were observed in patients at CKD stage 3 b. CONCLUSION: CVD Patients with early CKD who had controlled blood pressure, glucose and took RASi therapy showed no excess risk of all-cause and cardiovascular death compared to the those without CKD.