Impact of chronic kidney disease on mortality and cardiovascular outcomes after acute coronary syndrome: A nationwide data linkage study (ANZACS‐QI 44)

Abstract

Aims Chronic kidney disease (CKD) is associated with an increased risk of cardiovascular disease (CVD). We examined the characteristics, management and outcomes of patients with CKD in the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS‐QI) national registry. Methods The cohort comprised New Zealand (NZ) patients with an acute coronary syndrome undergoing coronary angiography between January 2013 and December 2016. Patients were categorized according to their stage of CKD. Outcomes included all‐cause and cause‐specific mortality and hospitalization with myocardial infarction (MI), stroke and major bleeding. Results Of the 20 604 patients, 20.3% had normal renal function, with 53.3%, 23.3%, 1.7% and 1.4% having CKD stages 2, 3, 4 and 5 CKD, respectively. Patients with severe CKD were more likely to be Māori or Pacific and live in an area with greater socioeconomic deprivation. Death, recurrent MI or stroke, and major bleeding all increased incrementally with each worsening stage of CKD severity. Compared with those with normal renal function, patients with stage 5 CKD had a much higher all‐cause (hazard ratio [HR] 16.41, 95% CI 13.06‐20.61), cardiovascular (HR 16.38, 95% CI 12.17‐22.04) and non‐cardiovascular mortality (HR 13.66 9, 95% CI.56‐19.51). In addition, patients with stage 5 CKD were at a higher risk of recurrent MI or stroke (HR 4.73, 95% CI 3.86‐5.80) and bleeding (HR 5.84, 95% CI 4.39‐7.76). Conclusion CKD was associated with increased mortality and a high incidence of morbidity in patients undergoing coronary angiography in New Zealand. Initiatives to understand and improve outcomes in this group of patients are urgently needed.

TCA cycle metabolites associated with adverse outcomes after acute coronary syndrome: mediating effect of renal function

“…Since the eGFR range in our sample was close to what is considered a normal renal function (age 64.9 ± 12.3, eGFR 62.1–96.7) it is reasonable to postulate that dysregulation of TCA cycle metabolism has preceded the development of kidney disease ( 9 ). Given that declined renal function is presented after ACS and is one of the main risk factors for cardiovascular outcomes and mortality ( 37 ), our results suggest that TCA cycle metabolites are associated with higher risk of clinical outcomes following ACS possibly due to renal decline. The causative mechanisms by which impaired kidney function contributes to cardiovascular diseases are not fully elucidated.…”

Functional state of kidneys in patients with acute myocardial infarction

“…До них слід віднести: вік, коморбідність, супутні захворювання -артеріальна гіпертензія (АГ), цукровий діабет (ЦД), ожиріння тощо [1]. Особливо слід виділити функціональний стан нирок, що може розглядатись, з одного боку, як маркер прогнозу цілої низки серцево-судинних захворювань, з іншого боку,саме супутні захворювання серцево-судинної системи, ЦД, АГ впливають на перебіг та прогресування захворювань нирок [2]. Швидкість клубочкової фільтрації (ШКФ) є раннім та чутливим маркером функціонального стану нирок та може використовуватись як для діагностики, так і для прогнозування перебігу серцево-судинних захворювань [3].…”

Main factors influencing long-term outcomes of liver transplantation in 2022

“…Many studies have reported an increased risk of death, myocardial infarction, stroke, and major bleeding in chronic kidney disease, especially in its most severe stages[ 66 ]; thus, preventing renal deterioration and preserving its function may be a key element in the management of transplanted patients.…”