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Prognostic implications of chronic kidney disease and anemia after percutaneous coronary intervention in acute myocardial infarction patients

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Abstract

Anemia is a common complication of chronic kidney disease (CKD), and a few studies suggest that both CKD and anemia have a marked impact on the prognosis of patients with cardiovascular disease. We retrospectively analyzed the prevalence of CKD and anemia in 312 patients with acute myocardial infarction (AMI). The patients were divided into four groups according to the presence of CKD and anemia. Chronic kidney disease was defined as estimated glomerular filtration rate <60 ml/min/1.73 m2, and anemia was defined according to the World Health Organization definition. Of 312 AMI patients, 166 (53.2%) had CKD and 87 (27.8%) had anemia. A powerful relationship was observed between both CKD and anemia and major adverse cardiac and cerebrovascular events (MACCE) or death by any cause. After adjustment for comorbidities, the hazard ratio (HR) for MACCE was significantly higher in the anemia-only group (HR 5.42, 95% confidence interval (CI) 1.38–21.27, P = 0.015), the CKD-only group (HR 6.4, 95% CI 2.09–19.58, P = 0.001), and the CKD and anemia group (HR 11.61, 95% CI 3.65–36.89, P < 0.001). With respect to death by any cause, the HR was significantly higher in the CKD-only group (HR 2.68, 95% CI 1.02–7.02, P = 0.045) and the CKD and anemia group (HR 4.40, 95% CI 1.56–12.43, P = 0.005). One-half of the patients with AMI had CKD as well. Furthermore, when anemia coexisted with CKD, these conditions had a multiplicative amplification effect on the risk of MACCE and death by any cause in patients with AMI.

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References

  1. Koide K, Yoshikawa T, Nagatomo Y, Kohsaka S, Anzai T, Meguro T, Ogawa S (2010) Elevated troponin T on discharge predicts poor outcome of decompensated heart failure. Heart Vessels 25:217–222

    Article  PubMed  Google Scholar 

  2. Manjunath G, Tighiouart H, Ibrahim H, MacLeod B, Salem DN, Griffith JL, Coresh J, Levey AS, Sarnak MJ (2003) Level of kidney function as a risk factor for atherosclerotic cardiovascular outcomes in the community. J Am Coll Cardiol 41:47–55

    Article  PubMed  Google Scholar 

  3. Anavekar NS, McMurray JJ, Velazquez EJ, Solomon SD, Kober L, Rouleau JL, White HD, Nordlander R, Maggioni A, Dickstein K, Zelenkofske S, Leimberger JD, Califf RM, Pfeffer MA (2004) Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction. N Engl J Med 351:1285–1295

    Article  PubMed  CAS  Google Scholar 

  4. Kimura H, Hiramitsu S, Miyagishima K, Mori K, Yoda R, Kato S, Kato Y, Morimoto S, Hishida H, Ozaki Y (2010) Cardio-renal interaction: impact of renal function and anemia on the outcome of chronic heart failure. Heart Vessels 25:306–312

    Article  PubMed  Google Scholar 

  5. Ninomiya T, Kiyohara Y, Kubo M, Tanizaki Y, Doi Y, Okubo K, Wakugawa Y, Hata J, Oishi Y, Shikata K, Yonemoto K, Hirakata H, Iida M (2005) Chronic kidney disease and cardiovascular disease in a general Japanese population: the Hisayama Study. Kidney Int 68:228–236

    Article  PubMed  Google Scholar 

  6. Irie F, Iso H, Sairenchi T, Fukasawa N, Yamagishi K, Ikehara S, Kanashiki M, Saito Y, Ota H, Nose T (2006) The relationships of proteinuria, serum creatinine, glomerular filtration rate with cardiovascular disease mortality in Japanese general population. Kidney Int 69:1264–1271

    Article  PubMed  CAS  Google Scholar 

  7. Shiba N, Matsuki M, Takahashi J, Tada T, Watanabe J, Shimokawa H (2008) Prognostic importance of chronic kidney disease in Japanese patients with chronic heart failure. Circ J 72:173–178

    Article  PubMed  CAS  Google Scholar 

  8. Kiyosue A, Hirata Y, Ando J, Fujita H, Morita T, Takahashi M, Nagata D, Kohro T, Imai Y, Nagai R (2010) Relationship between renal dysfunction and severity of coronary artery disease in Japanese patients. Circ J 74:786–791

    Article  PubMed  CAS  Google Scholar 

  9. Horwich TB, Fonarow GC, Hamilton MA, MacLellan WR, Borenstein J (2002) Anemia is associated with worse symptoms, greater impairment in functional capacity and a significant increase in mortality in patients with advanced heart failure. J Am Coll Cardiol 39:1780–1786

    Article  PubMed  Google Scholar 

  10. Bansal N, Tighiouart H, Weiner D, Griffith J, Vlagopoulos P, Salem D, Levin A, Sarnak MJ (2007) Anemia as a risk factor for kidney function decline in individuals with heart failure. Am J Cardiol 99:1137–1142

    Article  PubMed  Google Scholar 

  11. 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 

  12. McCullough PA, Jurkovitz CT, Pergola PE, McGill JB, Brown WW, Collins AJ, Chen SC, Li S, Singh A, Norris KC, Klag MJ, Bakris GL (2007) For the KEEP Investigators: independent components of chronic kidney disease as a cardiovascular risk state: results from the Kidney Early Evaluation Program (KEEP). Arch Intern Med 167:1122–1129

    Article  PubMed  CAS  Google Scholar 

  13. Keough-Ryan TM, Kiberd BA, Dipchand CS, Cox JL, Rose CL, Thompson KJ, Clase CM (2005) Outcomes of acute coronary syndrome in a large Canadian cohort: impact of chronic renal insufficiency, cardiac interventions, and anemia. Am J Kidney Dis 46:845–855

    Article  PubMed  Google Scholar 

  14. Imai E, Horio M, Nitta K, Yamagata K, Iseki K, Hara S, Ura N, Kiyohara Y, Hirakata H, Watanabe T, Moriyama T, Ando Y, Inaguma D, Narita I, Iso H, Wakai K, Yasuda Y, Tsukamoto Y, Ito S, Makino H, Hishida A, Matsuo S (2007) Estimation of glomerular filtration rate by the MDRD Study equation modified for Japanese patients with chronic kidney disease. Clin Exp Nephrol 11:41–50

    Article  PubMed  Google Scholar 

  15. Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, Yamagata K, Tomino Y, Yokoyama H, Hishida A, et al (2009) Collaborators developing the Japanese equation for estimated GFR. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis 53:982–992

    Article  PubMed  CAS  Google Scholar 

  16. Thygesen K, Alpert JS, White HD, Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction, Jaffe AS, Apple FS, Galvani M, Katus HA, Newby LK, Ravkilde J, Chaitman B, Clemmensen PM, Dellborg M, Hod H, Porela P, Underwood R, Bax JJ, Beller GA, Bonow R, Van der Wall EE, Bassand JP, Wijns W, Ferguson TB, Steg PG, Uretsky BF, Williams DO, Armstrong PW, Antman EM, Fox KA, Hamm CW, Ohman EM, Simoons ML, Poole-Wilson PA, Gurfinkel EP, Lopez-Sendon JL, Pais P, Mendis S, Zhu JR, Wallentin LC, Fernández-Avilés F, Fox KM, Parkhomenko AN, Priori SG, Tendera M, Voipio-Pulkki LM, Vahanian A, Camm AJ, De Caterina R, Dean V, Dickstein K, Filippatos G, Funck-Brentano C, Hellemans I, Kristensen SD, McGregor K, Sechtem U, Silber S, Tendera M, Widimsky P, Zamorano JL, Morais J, Brener S, Harrington R, Morrow D, Lim M, Martinez-Rios MA, Steinhubl S, Levine GN, Gibler WB, Goff D, Tubaro M, Dudek D, Al-Attar N (2007) Universal definition of myocardial infarction. Circulation 116:2634–2653

    Google Scholar 

  17. World Health Organization (1999) Definition, diagnosis, and classification of diabetes mellitus and its complications. Report of a WHO consultation. Part 1. World Health Organization, Geneva, pp 1–59

  18. National Kidney Foundation (2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 39:S1–S266

    Google Scholar 

  19. World Health Organization (1968) Nutritional anaemias. Report of a WHO Scientific Group. World Health Organization, Geneva

  20. Levin A, Singer J, Thompson CR, Ross H, Lewis M (1996) Prevalent left ventricular hypertrophy in the predialysis population: identifying opportunities for intervention. Am J Kidney Dis 27:347–354

    Article  PubMed  CAS  Google Scholar 

  21. Beattie JN, Soman SS, Sandberg KR, Yee J, Borzak S, Garg M, McCullough PA (2001) Determinants of mortality after myocardial infarction in patients with advanced renal dysfunction. Am J Kidney Dis 37:1191–1200

    Article  PubMed  CAS  Google Scholar 

  22. Langston RD, Presley R, Flanders WD, McClellan WM (2003) Renal insufficiency and anemia are independent risk factors for death among patients with acute myocardial infarction. Kidney Int 64:1398–1405

    Article  PubMed  Google Scholar 

  23. Imai E, Horio M, Nitta K, Yamagata K, Iseki K, Tsukamoto Y, Ito S, Makino H, Hishida A, Matsuo S (2007) Modification of the Modification of Diet in Renal Disease (MDRD) Study equation for Japan. Am J Kidney Dis 50:927–937

    Article  PubMed  Google Scholar 

  24. Fox CS, Muntner P, Chen AY, Alexander KP, Roe MT, Cannon CP, Saucedo JF, Kontos MC, Wiviott SD (2010) Acute Coronary Treatment and Intervention Outcomes Network registry: use of evidence-based therapies in short-term outcomes of ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction in patients with chronic kidney disease: a report from the National Cardiovascular Data Acute Coronary Treatment and Intervention Outcomes Network registry. Circulation 121:357–365

    Article  PubMed  CAS  Google Scholar 

  25. McClellan WM, Langston RD, Presley R (2004) Medicare patients with cardiovascular disease have a high prevalence of chronic kidney disease and a high rate of progression to end-stage renal disease. J Am Soc Nephrol 15:1912–1919

    Article  PubMed  Google Scholar 

  26. Azar RR, Prpic R, Ho KK, Kiernan FJ, Shubrooks SJ Jr, Baim DS, Popma JJ, Kuntz RE, Cohen DJ (2000) Impact of end-stage renal disease on clinical and angiographic outcomes after coronary stenting. Am J Cardiol 86:485–489

    Article  PubMed  CAS  Google Scholar 

  27. Best PJM, Berger PB, Davis BR, Grines CL, Sadeghi HM, Williams BA, Willerson JT, Granett JR, Holmes JDR (2004) Impact of mild or moderate chronic kidney disease on the frequency of restenosis: results from the PRESTO trial. J Am Coll Cardiol 44:1786–1791

    PubMed  Google Scholar 

  28. Szczech LA, Best PJ, Crowley E, Brooks MM, Berger PB, Bittner V, Gersh BJ, Jones R, Califf RM, Ting HH, Whitlow PJ, Detre KM, Holmes D (2002) Bypass Angioplasty Revascularization Investigation (BARI) Investigators. Outcomes of patients with chronic renal insufficiency in the bypass angioplasty revascularization investigation. Circulation 105:2253–2258

    Article  PubMed  CAS  Google Scholar 

  29. Appleby CE, Ivanov J, Lavi S, Mackie K, Horlick EM, Ing D, Overgaard CB, Seidelin PH, von Harsdorf R, Dzavík V (2009) The adverse long-term impact of renal impairment in patients undergoing percutaneous coronary intervention in the drug-eluting stent era. Circ Cardiovasc Interv 2:309–316

    Article  PubMed  Google Scholar 

  30. Iseki K, Fukiyama K (1996) Predictors of stroke in patients receiving chronic hemodialysis. Kidney Int 50:1672–1675

    Article  PubMed  CAS  Google Scholar 

  31. Parfrey PS (1993) Cardiac and cerebrovascular diseases in chronic uremia. Am J Kidney Dis 21:77–80

    PubMed  CAS  Google Scholar 

  32. Kawamura M, Fijimoto S, Hisanga S, Yamamoto Y, Eto T (1998) Incidence, outcome and risk factors of cerebrovascular events in patients undergoing maintenance hemodialysis. Am J Kidney Dis 31:991–996

    Article  PubMed  CAS  Google Scholar 

  33. Kokubo Y, Nakamura S, Okamura T, Yoshimasa Y, Makino H, Watanabe M, Higashiyama A, Kamide K, Kawanishi K, Okayama A, Kawano Y (2009) Relationship between blood pressure category and incidence of stroke and myocardial infarction in an urban Japanese population with and without chronic kidney disease: the Suita Study. Stroke 40:2674–2679

    Article  PubMed  Google Scholar 

  34. Dhingra R, Gaziano JM, Djoussé L (2011) Chronic kidney disease and the risk of heart failure in men. Circ Heart Fail 4:138–144

    Article  PubMed  Google Scholar 

  35. Hamaguchi S, Tsuchihashi-Makaya M, Kinugawa S, Yokota T, Ide T, Takeshita A, Tsutsui H, et al (2009) The JCARE-CARD Investigators. Chronic kidney disease as an independent risk for long-term adverse outcomes in patients hospitalized with heart failure in Japan. Circ J 73:1442–1447

    Article  PubMed  Google Scholar 

  36. Groenveld HF, Januzzi JL, Damman K, van Wijngaarden J, Hillege HL, van Veldhuisen DJ, van der Meer P (2008) Anemia and mortality in heart failure patients a systematic review and meta-analysis. J Am Coll Cardiol 52:818–827

    Article  PubMed  Google Scholar 

  37. Yagi H, Kawai M, Komukai K, Ogawa T, Minai K, Nagoshi T, Ogawa K, Sekiyama H, Taniguchi I, Yoshimura M (2011) Impact of chronic kidney disease on the severity of initially diagnosed coronary artery disease and the patient prognosis in the Japanese population. Heart Vessels 26:370–378

    Article  PubMed  Google Scholar 

  38. Washida N, Wakino S, Hayashi K, Kuwahara T, Itoh H (2010) Brachial-ankle pulse wave velocity predicts silent cerebrovascular diseases in patients with end-stage renal diseases. J Atheroscler Thromb 17:165–172

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  40. Anand IS, Chandrashekhar Y, Ferrari R, Poole-Wilson PA, Harris PC (1993) Pathogenesis of oedema in chronic severe anaemia: studies of body water and sodium, renal function, haemodynamic variables, and plasma hormones. Br Heart J 70:357–362

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, Kameda Medical Center, 929 Higashi-chou, Kamogawa, Chiba, 296-8602, Japan

    Yuya Matsue, Akihiko Matsumura, Masami Abe, Maki Ono, Mie Seya, Tomofumi Nakamura, Ryota Iwatsuka, Akira Mizukami, Masahiko Setoguchi, Wataru Nagahori, Masakazu Ohno, Makoto Suzuki & Yuji Hashimoto

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  1. Yuya Matsue
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Correspondence to Yuya Matsue.

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Matsue, Y., Matsumura, A., Abe, M. et al. Prognostic implications of chronic kidney disease and anemia after percutaneous coronary intervention in acute myocardial infarction patients. Heart Vessels 28, 19–26 (2013). https://doi.org/10.1007/s00380-011-0209-2

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  • DOI: https://doi.org/10.1007/s00380-011-0209-2

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