The Prevalence of Nontraditional Risk Factors for Coronary Heart Disease in Patients with Chronic Kidney Disease

Muntner, Paul; Hamm, L. Lee; Kusek, John W.; Chen, Jing; Whelton, Paul K.; He, Jiang

doi:10.7326/0003-4819-140-1-200401060-00006

Cited by 368 publications

(236 citation statements)

References 42 publications

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“…Even after adjustments for demographic, medical, angiographic and procedural variables, the eGFR remained a significant risk for in-hospital all-cause and cardiac mortality. The increase in mortality with a reduced eGFR can be partly explained by nontraditional factors associated with CKD, including increased inflammatory factor levels, 31 elevated homocysteine levels, 32 enhanced coagulability 31 and endothelial dysfunction, 33 which were not assessed in this study.…”

Section: Discussionmentioning

confidence: 96%

Decreased glomerular filtration rate is a significant and independent risk for in-hospital mortality in Japanese patients with acute myocardial infarction: report from the Hokkaido acute myocardial infarction registry

et al. 2012

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on behalf of Hokkaido Acute Myocardial Infarction Registry InvestigatorsRenal dysfunction is a significant risk factor in the prognosis of patients with cardiovascular diseases. We sought to determine the relationship between estimated glomerular filtration rate (eGFR) values and in-hospital mortality in Japanese acute myocardial infarction (AMI) patients. A total of 2266 consecutive AMI patients admitted to 22 hospitals in Hokkaido were registered. The eGFR values were determined using the following equation: eGFR¼194Â(serum creatinine) À1.094 Â(age) À0.287 (Â0.739 if female). Patients were classified into four groups according to their eGFR values: X60 (n¼1304), 30-59 (n¼810), 15-29 (n¼87) and o15 ml min À1 per 1.73 m 2 (n¼65). A total of 110 patients (4.9%) died during hospitalization. The in-hospital mortality rate was significantly higher in patients with reduced eGFR values at 2.3, 5.4, 24.1 and 23.1% for eGFR values of X60, 30-59, 15-29, and o15 ml min À1 per 1.73 m 2 , respectively. The odds ratios for in-hospital all cause death were 8.26 (95% confidence interval (CI): 2.22-30.77) for eGFRo15 ml min À1 per 1.73 m 2 and 3.42 (95% CI: 1.01-11.61) for eGFR 15-29 ml min À1 per 1.73 m 2 compared with eGFR X60 ml min À1 per 1.73 m 2 . Similarly, the odds ratios for in-hospital cardiac death were 8.43 (95% CI: 1.82-39.05) for eGFRo15 ml min À1 per 1.73 m 2 and 5.47 (95% CI: 1.51-19.80) for eGFR 15-29 ml min À1 per 1.73 m 2 . In conclusion, the eGFR of o30 ml min À1 per 1.73 m 2 was a significant and independent risk for in-hospital mortality in abroad cohort of Japanese patients with AMI.

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Section: Discussionmentioning

confidence: 96%

Decreased glomerular filtration rate is a significant and independent risk for in-hospital mortality in Japanese patients with acute myocardial infarction: report from the Hokkaido acute myocardial infarction registry

et al. 2012

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“…Atherosclerosis is today considered to be, in part, an inflammatory disease [27]. Impaired renal function is also associated with increased inflammatory activity [28,29] and other factors that are considered to be important for the development of CVD, such as endothelial dysfunction, increased endothelin production [29,30] and increased sympathetic nerve activity [30]. Thus, there are many similarities between CVD and CKD patients, and the pathogenesis of renal impairment and atherosclerotic vascular disease may share several common features.…”

Section: Discussionmentioning

confidence: 99%

Prognostic implications of renal dysfunction in patients with stable angina pectoris

Almquist

Forslund

Rehnqvist

et al. 2006

Journal of Internal Medicine

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Objective. Impaired renal function is emerging as an independent risk factor for cardiovascular (CV) disease. We analysed the prognostic implications of estimated renal function in patients with angina pectoris. Design. Post hoc analysis of the Angina Prognosis Study In Stockholm (APSIS). The estimated creatinine clearance (eCrCl) was calculated according to the Cockcroft-Gault formula in 808 patients. Outcomes were compared for subgroups with CrCl ‡90, 60-89 and<60 mL min )1 . Setting. Hospital-based study with patients referred from primary care and hospital. Subjects. A total of 809 patients (248 women) with clinically diagnosed stable angina pectoris. Intervention. Double-blind treatment with metoprolol or verapamil.Results. One hundred and sixty-four patients (91 women) had an eCrCl below 60 mL min )1 . During a median follow-up of 40 months, 38 patients suffered CV death and 31 patients had a nonfatal myocardial infarction (MI). In a univariate analysis a lower eCrCl was related to a higher risk for CV death or MI amongst men (log rank P ¼ 0.036). A multivariate Cox analysis showed an independent prognostic importance of eCrCl for CV death (P ¼ 0.046) and for CV death or MI (P ¼ 0.042) amongst all patients. When analysed as a continuous variable, a 1 mL min )1 decrease in eCrCl was associated with a 1.6% (0.1-3.1) increase in the risk for CV death or MI, and a 2.1% (0-4.1) increase in the risk for CV death alone. Conclusion. Renal dysfunction was found to be common in patients with stable angina pectoris and estimated creatinine clearances carried significant independent prognostic information regarding CV death and nonfatal MI.

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“…Patients with chronic kidney disease have been believed to have elevated inflammation markers, leading to a state of accelerated atherosclerosis, which may partially cause worse clinical outcomes as an eGFR became lower. 25,[28][29][30] Other explanations may be conditions associated with Figure 3 Kaplan-Meier survival curves (a), cardiovascular event-free curves (b), readmission for heart failure-free curves (c) and target lesion revascularization (TLR)-free curves (d) among patients undergoing percutaneous coronary intervention (n¼426) according to the estimated glomerular filtration rate (GFR) value. Cardiovascular events were composed of cardiac death, nonfatal myocardial infarction or readmission for heart failure.…”

Section: Clinical Outcomesmentioning

confidence: 99%

Impact of reduced renal function on prognosis in Japanese patients with coronary artery disease: a prospective cohort of Shinken Database 2007

et al. 2009

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Patients with coronary artery disease (CAD) frequently have impaired renal function, but the prevalence and influence of renal dysfunction on their prognosis in Japan remain uncertain. With a prospective study comprising all the new patients who had visited our hospital between 2004 and 2007 (n¼6562), we investigated the prevalence of renal dysfunction and its influence on the prognosis of CAD patients. The glomerular filtration rate (GFR) was calculated by using the GFR equation used for the Japanese population. Of those, 797 patients with CAD and blood tests available were analyzed (median follow-up periods of 693 days). Patients were further classified into four subgroups according to estimated GFR value (eGFR): normal (90peGFR, 12.2%), mildly impaired (60peGFRo90, 58.3%), moderately impaired (30peGFRo60, 23.6%) and severely impaired renal function (eGFRo30, 5.9%). The 2-year survival and cardiovascular event (cardiac death, nonfatal myocardial infarction or readmission for heart failure)-free rates were significantly different among the four subgroups: 98.9, 97.7, 89.3 vs. 67.8%, respectively (Po0.001 for trend), and 100, 98.8, 89.0 vs. 70.0%, respectively (Po0.001 for trend). The age-and gender-adjusted mortality increased significantly in moderately impaired (hazard ratio (HR) 3.1, 95% confidence interval (CI) 1.383-7.017) and in severely impaired subgroups (HR 10.1, 95% CI 4.244-24.178) compared with those with eGFR of 60 or more. After adjustment for baseline differences, eGFR was independently associated with death and cardiovascular events (HR 0.983 and 0.981, 95% CI 0.968-0.998 and 0.965-0.998, respectively). In conclusion, our study identified the prevalence and association of eGFR with prognosis in Japanese patients with CAD, suggesting that strict care for not only CAD but also renal dysfunction is needed for further prevention of cardiovascular events.

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The Prevalence of Nontraditional Risk Factors for Coronary Heart Disease in Patients with Chronic Kidney Disease

Abstract: Levels of apolipoprotein A1 are decreased and levels of homocysteine, lipoprotein(a), fibrinogen, and C-reactive protein are increased among patients with chronic kidney disease.

Cited by 368 publications

References 42 publications

Decreased glomerular filtration rate is a significant and independent risk for in-hospital mortality in Japanese patients with acute myocardial infarction: report from the Hokkaido acute myocardial infarction registry

Decreased glomerular filtration rate is a significant and independent risk for in-hospital mortality in Japanese patients with acute myocardial infarction: report from the Hokkaido acute myocardial infarction registry

Prognostic implications of renal dysfunction in patients with stable angina pectoris

Impact of reduced renal function on prognosis in Japanese patients with coronary artery disease: a prospective cohort of Shinken Database 2007

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