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Low eGFR and albuminuria independently predict all-cause mortality in high-risk subjects undergoing coronary arteriography

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Abstract

Individuals with Chronic Kidney Disease (CKD) are at high risk for cardiovascular morbidity and mortality. The aim of this study was to examine the relationship between renal dysfunction and all-cause mortality in a sample of subjects undergoing coronary angiography (CA). We evaluated 1017 subjects who consecutively underwent CA. Glomerular filtration rate (eGFR) was estimated by CKD-EPI and urinary albumin excretion reported as urinary albumin-to-creatinine ratio. Vital status was ascertained by interrogating the Italian Health Card Database. One-thousand-seventeen subjects (759 M/258F) were enrolled into the study from 2016 to 2018. One-hundred-fourteen deaths occurred during a median follow-up of 44 months. The whole population was divided in two subgroups according to the presence/absence of low eGFR (i.e. < 60 ml/min/1.73 m2). Subjects with low baseline eGFR had a worse clinical profile than subjects with preserved kidney function. The risk of death in subjects with eGFR < 60 ml/min/1.73 m2 was almost three times higher than in subjects with preserved kidney function: fully adjusted HR 2.70 (95% CI 1.56–4.67). The presence of albuminuria also predicted a high risk of death: fully adjusted HR 2.09 (95% CI 1.17–3.73) and HR 4.26 (95% CI 2.18–8.33), microalbuminuria or macroalbuminuria, respectively, being normoalbuminuria the reference group. Again, the increased risk remained significant after adjusting for several potential confounders. In conclusion, kidney disease measures (i.e. low eGFR or albuminuria) independently predict increased risk for all-cause death in a large sample of subjects undergoing CA. These results have a relevant clinical impact.

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Funding

This research was founded by Italian Minister of Health Ricerca Corrente 2020.

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Authors and Affiliations

  1. Unit of Internal Medicine, Fondazione IRCCS Casa Sollievo Della Sofferenza, Viale dei Cappuccini snc, 71013, San Giovanni Rotondo, FG, Italy

    Maria Maddalena D’Errico, Pamela Piscitelli, Antonio Mirijello, Mariateresa Santoliquido, Valentina Massa & Salvatore A. De Cosmo

  2. Geriatrics Residency School, University of Foggia, Foggia, FG, Italy

    Mariateresa Santoliquido

  3. Unit of Cardiology, Fondazione IRCCS Casa Sollievo Della Sofferenza, Viale Cappuccini snc, 71013, San Giovanni Rotondo, FG, Italy

    Mauro Salvatori & Carlo Vigna

  4. Internal Medicine Residency School, University of Foggia, Foggia, FG, Italy

    Gianluigi Vendemiale

  5. Unit of Nephrology and Hemodialysis, Fondazione IRCCS Casa Sollievo Della Sofferenza, Viale Cappuccini snc, 71013, San Giovanni Rotondo, FG, Italy

    Filippo Aucella

  6. Università Degli Studi and IRCCS Ospedale Policlinico San Martino, Genoa, Italy

    Roberto Pontremoli

Authors
  1. Maria Maddalena D’Errico
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  2. Pamela Piscitelli
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  3. Antonio Mirijello
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  4. Mariateresa Santoliquido
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  5. Valentina Massa
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  6. Mauro Salvatori
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  7. Carlo Vigna
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  8. Gianluigi Vendemiale
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  9. Filippo Aucella
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  10. Roberto Pontremoli
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  11. Salvatore A. De Cosmo
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Contributions

MMD: conceived and designed the study, analyzed and interpreted the data, wrote and reviewed the manuscript. PP collected data, contributed to writing and discussion, reviewed the manuscript. AM: collected data, contributed to discussion, reviewed the manuscript. MTS: collected data, contributed to discussion, reviewed manuscript. MS collected data, contributed to discussion, reviewed manuscript. CV: collected data, performed the coronary arteriography, contributed to discussion, reviewed the manuscript. GV: contributed to discussion, reviewed the manuscript. FA: contributed to discussion, reviewed the manuscript. RP: contributed to discussion, reviewed the manuscript. SDC: conceived and designed the study, analyzed and interpreted the data, wrote and reviewed the manuscript.

Corresponding author

Correspondence to Salvatore A. De Cosmo.

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No conflicts to declare. The results presented in this article have not been published previously in whole or in part.

Human and animal rights

The study was performed according to the Helsinki Declaration, and the protocol was approved by the local Ethics Committee.

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All subjects provided written informed consent.

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D’Errico, M.M., Piscitelli, P., Mirijello, A. et al. Low eGFR and albuminuria independently predict all-cause mortality in high-risk subjects undergoing coronary arteriography. Intern Emerg Med 17, 695–701 (2022). https://doi.org/10.1007/s11739-021-02851-4

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