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Glomerular filtration rate is related to severity of obstructive coronary artery disease in patients undergoing coronary angiography

  • Nephrology - Original Paper
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Abstract

Purpose

Chronic kidney disease is independently associated with an increased risk of cardiovascular events; however, the relationship between the glomerular filtration rate (GFR) and coronary artery disease (CAD) in patients undergoing coronary angiography has yet to be fully elucidated.

Methods

This retrospective study enrolled a total of 7968 patients who underwent diagnostic coronary artery catheterization [mean age = 54.8 ± 10.6 years, 74.4% males] and did not have any previous history of coronary revascularization, diabetes mellitus, hypertension, end-stage renal disease treated by dialysis or renal transplantation, and were not taking diuretics or drugs acting on renin angiotensin system. The severity of CAD was defined as the number of coronary arteries with a luminal stenosis ≥50% on the angiogram, and the GFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI).

Results

There were 2133 (26.8%) patients with GFR ≥ 90 ml/min/1.73 m2, 4574 (57.4%) patients with 60 ≤ GFR < 90 ml/min/1.73 m2, 1073 (13.5%) with 45 ≤ GFR < 60 ml/min/1.73 m2 and 181 (2.3%) with 15 < GFR < 45 ml/min/1.73 m2. After adjustment for traditional cardiovascular risk factors (age, sex, dyslipidemia, low to high-density lipoprotein ratio, smoking status, and family history), the GFR showed a significant association with the severity of CAD and remained a significant predictor of CAD (Odds Ratio raised from 1.1 in patients with 60 ≤ GFR < 90 ml/min/1.73 m2 to 1.8 in patients with 15 < GFR < 45 ml/min/1.73 m2).

Conclusions

A reduced kidney function, even mildly, is significantly associated with CAD severity, independently of other traditional CAD risk factors.

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References

  1. Sarnak MJ, Coronado BE, Greene T, Wang SR, Kusek JW, Beck GJ et al (2002) Cardiovascular disease risk factors in chronic renal insufficiency. Clin Nephrol 57:327–335

    PubMed  CAS  Google Scholar 

  2. Shulman NB, Ford CE, Hall WD, Blaufox MD, Simon D, Langford HG et al (1989) Prognostic value of serum creatinine and effect of treatment of hypertension on renal function. Results from the hypertension detection and follow-up program. The Hypertension detection and follow-up program cooperative group. Hypertension 13:I80–I193

    PubMed  CAS  Google Scholar 

  3. Solak Y, Akilli H, Atalay H, Kayrak M, Gok H, Turk S (2010) The association of glomerular filtration rate and erectile dysfunction with severity of coronary artery disease in patients presenting with chest pain. Int Urol Nephrol 42:765–771

    Google Scholar 

  4. Muntner P, He J, Hamm L, Loria C, Whelton PK (2002) Renal insufficiency and subsequent death resulting from cardiovascular disease in the United States. J Am Soc Nephrol 13:745–753

    PubMed  Google Scholar 

  5. Beddhu S, Allen-Brady K, Cheung AK, Horne BD, Bair T, Muhlestein JB et al (2002) Impact of renal failure on the risk of myocardial infarction and death. Kidney Int 62:1776–1783

    Article  PubMed  Google Scholar 

  6. Henry RMA, Kostense PJ, Bos G, Dekker JM, Nijpels G, Heine RJ et al (2002) Mild renal insufficiency is associated with increased cardiovascular mortality: The Hoorn Study. Kidney Int 62:1402–1407

    Article  PubMed  Google Scholar 

  7. Go AS, Chertow GM, Fan D, McCulloch CE, Hsu C (2004) Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Eng J Med 351:1296–1305

    Article  CAS  Google Scholar 

  8. Manjunath G, Tighiouart H, Coresh J, Macleod B, Salem DN, Griffith JL et al (2003) Level of kidney function as a risk factor for cardiovascular outcomes in the elderly. Kidney Int 63:1121–1129

    Article  PubMed  Google Scholar 

  9. Mann JFE, Gerstein HC, Pogue J, Bosch J, Yusuf S (2001) Renal insufficiency as a predictor of cardiovascular outcomes and the impact of ramipril: the HOPE randomized trial. Ann Intern Med 134:629–636

    PubMed  CAS  Google Scholar 

  10. Best PJM, Lennon R, Ting HH, Bell MR, Rihal CS, Holmes DR Jr et al (2002) The impact of renal insufficiency on clinical outcomes in patients undergoing percutaneous coronary interventions. J Am Coll Cardiol 39:1113–1119

    Article  PubMed  Google Scholar 

  11. Wison S, Foo K, Cunningham J, Cooper J, Deaner A, Knight C et al (2003) Renal function and risk stratification in acute coronary syndromes. Am J Cardiol 91:1051–1054

    Article  PubMed  Google Scholar 

  12. Jungers P, Massy ZA, Nguyen Khoa T, Fumeron C, Labrunie M, Lacour B et al (1997) Incidence and risk factors of atherosclerotic cardiovascular accidents in predialysis chronic renal failure patients: a prospective study. Nephrol Dial Transplant 12:2597–2602

    Article  PubMed  CAS  Google Scholar 

  13. Reis SE, Olson MB, Fried L, Reeser V, Mankad S, Pepine CJ et al (2002) Mild renal insufficiency is associated with angiographic coronary artery disease in women. Circulation 105:2826–2829

    Article  PubMed  Google Scholar 

  14. Khalique O, Aronow WS, Ahn C, Mazar M, Schair B, Shao J et al (2007) Relation of moderate or severe reduction in glomerular filtration rate to number of coronary arteries narrowed >50% in patients undergoing coronary angiography for suspected coronary artery disease. Am J Cardiol 100:415–416

    Article  PubMed  Google Scholar 

  15. Garg AX, Clark WF, Haynes RB, House AA (2002) Moderate renal insufficiency and the risk of cardiovascular mortality: results from the NHANES I. Kidney Int 61:1486–1494

    Article  PubMed  Google Scholar 

  16. Culleton BF, Larson MG, Wilson PWF, Evans JC, Parfrey PS, Levy D (1999) Cardiovascular disease and mortality in a community-based cohort with mild renal insufficiency. Kidney Int 56:2214–2219

    Article  PubMed  CAS  Google Scholar 

  17. Brancati FL, Whelton P, Randali B (1997) Risk of end-stage renal disease in diabetes mellitus: a prospective cohort study of men screened for MRIIF. Multiple risk factor intervention trial. JAMA 278:2069–2074

    Article  PubMed  CAS  Google Scholar 

  18. Klag MJ, Whelton PK, Randall BL, Neaton JD, Brancati FL, Ford CE et al (1996) Blood pressure and end-stage renal disease in men. N Engl J Med 334:13–18

    Article  PubMed  CAS  Google Scholar 

  19. Scanlon PJ, Faxon DP, Audet AM, Carabello B, Dehmer GJ, Eagle KA et al (1999) ACC/AHA guidelines for coronary angiography: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Coronary Angiography) developed in collaboration with the Society for Cardiac Angiography and Interventions. J Am Coll Cardiol 33:1756–1824

    Article  PubMed  CAS  Google Scholar 

  20. Cirillo M (2010) Evaluation of glomerular filtration rate and of albuminuria/proteinuria. J Nephrol 23:125–132

    PubMed  CAS  Google Scholar 

  21. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF, Feldman HI et al (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150:604–612

    PubMed  Google Scholar 

  22. Eknoyan G, Levin NW, K/DOQI (2002) Clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 39:1–266

    Article  Google Scholar 

  23. American College of Cardiology National Cardiovascular Data Registry, Cardiac Catheterization Module 3.04 DDA, http://www.ncdr.com/WebNCDR/NCDRDocuments/a,datadictdefsonlyv30.pdf. Accessed Dec 1

  24. Agresti A (2002) Categorical Data Analysis. John Wiley & Sons, Boston

    Book  Google Scholar 

  25. Sarnak MJ, Levey AS (2000) Cardiovascular disease, chronic renal disease: a new paradigm. Am J Kidney Dis 35:117–131

    Article  Google Scholar 

  26. Shlipak MG, Fried LF, Crump C, Bleyer AJ, Manolio TA, Tracy RP et al (2003) Elevations of inflammatory and procoagulant biomarkers in elderly persons with renal insufficiency. Circulation 107:87–92

    Article  PubMed  CAS  Google Scholar 

  27. Knight EL, Rimm EB, Pai JK, Rexrode KM, Cannuscio CC, Manson JAE et al (2004) Kidney dysfunction, inflammation, and coronary events: a prospective study. J Am Soc Nephrol 15:1897–1903

    Article  PubMed  Google Scholar 

  28. Zimmermann J, Herrlinger S, Pruy A, Metzger T, Wanner C (1999) Inflammation enhances cardiovascular risk and mortality in hemodialysis patients. Kidney Int 55:648–658

    Article  PubMed  CAS  Google Scholar 

  29. Zebrack JS, Anderson JL, Beddhu S, Horne BD, Bair TL, Cheung A et al (2003) Do associations with C-Reactive protein and extent of coronary artery disease account for the increased cardiovascular risk of renal insufficiency? J Am Coll Cardiol 42:57–63

    Article  PubMed  CAS  Google Scholar 

  30. Astor BC, Coresh J, Heiss G, Pettitt D, Sarnak MJ (2006) Kidney function and anemia as risk factors for coronary heart disease and mortality: the Atherosclerosis Risk in Communities (ARIC) Study. Am Heart J 151:492–500

    Article  PubMed  Google Scholar 

  31. Tonelli M, Sacks F, Pfeffer M, Gao Z, Curhan G (2005) Relation between serum phosphate level and cardiovascular event rate in people with coronary disease. Circulation 112:2627–2633

    Article  PubMed  CAS  Google Scholar 

  32. Goodman WG, Goldin J, Kuizon BD, Yoon C, Gales B, Sider D et al (2000) Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis. N Engl J Med 342:1478–1483

    Article  PubMed  CAS  Google Scholar 

  33. Lishmanov A, Dorairajan S, Pak Y, Chaudhary K, Chockalingam A (2011) Elevated serum parathyroid hormone is a cardiovascular risk factor in moderate chronic kidney disease. Int Urol Nephrol 43:161–173

    Google Scholar 

  34. Koenig W, Twardella D, Brenner H, Rothenbacher D (2005) Plasma concentrations of cystatin C in patients with coronary heart disease and risk for secondary cardiovascular events: more than simply a marker of glomerular filtration rate. Clin Chem 51:321–327

    Article  PubMed  CAS  Google Scholar 

  35. Eikelboom JW, Lonn E, Genest J, Hankey G, Yusuf S (1999) Homocysteine and cardiovascular disease: a critical review of the epidemiologic evidence. Ann Internal Med 131:363–375

    CAS  Google Scholar 

  36. Bostom AG, Lathrop L (1997) Hyperhomocysteinemia in end-stage renal disease: prevalence, etiology, and potential relationship to arteriosclerotic outcomes. Kidney Int 52:10–20

    Article  PubMed  CAS  Google Scholar 

  37. Anderson JL, Muhlestein JB, Horne BD, Carlquist JF, Bair TL, Madsen TE et al (2000) Plasma homocysteine predicts mortality independently of traditional risk factors and C-reactive protein in patients with angiographically defined coronary artery disease. Circulation 102:1227–1232

    Article  PubMed  CAS  Google Scholar 

  38. Fang J, Alderman MH (2000) Serum uric acid and cardiovascular mortality the NHANES I epidemiologic follow-up study, 1971–1992. National Health and Nutrition Examination Survey. JAMA 283:2404–2410

    Article  PubMed  CAS  Google Scholar 

  39. Gesquière L, Loreau N, Minnich A, Davignon J, Blache D (1999) Oxidative stress leads to cholesterol accumulation in vascular smooth muscle cells. Free Radic Biol Med 27:134–145

    Article  PubMed  Google Scholar 

  40. Kanani PM, Sinkey CA, Browning RL, Allaman M, Knapp HR, Haynes WG (1999) Role of oxidant stress in endothelial dysfunction produced by experimental hyperhomocysteinemia in humans. Circulation 100:1161–1168

    Article  PubMed  CAS  Google Scholar 

  41. Koch M, Kutkuhn B, Trenkwalder E, Bach D, Grabensee B, Dieplinger H et al (1997) Apolipoprotein B, fibrinogen, HDL cholesterol, and apolipoprotein (a) phenotypes predict coronary artery disease in hemodialysis patients. J Am Soc Nephrol 8:1889–1898

    PubMed  CAS  Google Scholar 

  42. Muntner P, He J, Astor BC, Folsom AR, Coresh J (2005) Traditional and nontraditional risk factors predict coronary heart disease in chronic kidney disease: results from the atherosclerosis risk in communities study. J Am Soc Nephrol 16:529–538

    Article  PubMed  Google Scholar 

  43. Romanic AM, Arleth AJ, Willette RN, Ohlstein EH (1998) Factor XIIIa cross-links lipoprotein (a) with fibrinogen and is present in human atherosclerotic lesions. Circ Res 83:264–269

    Article  PubMed  CAS  Google Scholar 

  44. Sechi LA, Zingaro L, Catena C, De Marchi S (2000) Increased fibrinogen levels and hemostatic abnormalities in patients with arteriolar nephrosclerosis: association with cardiovascular events. J Thromb Haemost 84:565–570

    CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, North Kargar Street, Tehran, Iran

    Gholamreza Davoodi, Samira Mehrabi Pari, Ali Kazemisaeid & Ahmad Yaminisharif

  2. Department of Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran

    Mehrnaz Rezvanfard, Mahmood Sheikh Fathollahi & Elham Hakki

  3. Department of Nephrology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

    Manouchehr Amini

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  1. Gholamreza Davoodi
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Correspondence to Gholamreza Davoodi.

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Davoodi, G., Mehrabi Pari, S., Rezvanfard, M. et al. Glomerular filtration rate is related to severity of obstructive coronary artery disease in patients undergoing coronary angiography. Int Urol Nephrol 44, 1161–1168 (2012). https://doi.org/10.1007/s11255-011-0070-3

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  • DOI: https://doi.org/10.1007/s11255-011-0070-3

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