Original Article| Volume 33, P93-97, September 2016

Severity of coronary artery disease is an independent risk factor for decline in kidney function


      • Chronic kidney disease (CKD) and cardiovascular disease are closely interrelated in a negative manner.
      • This study showed that coronary artery disease severity is an independent risk factor for decline in kidney function.
      • Patients with coronary artery disease should be also screened for existence of kidney disease.


      Background and aim

      Chronic kidney disease (CKD) and cardiovascular disease are closely interrelated and the presence of one condition synergistically affects the prognosis of the other, in a negative manner. There are surprisingly very few data on the relationship between baseline coronary artery disease (CAD) severity and subsequent decline in kidney function. We aimed to evaluate for the first time whether baseline coronary artery lesion severity predicts the decline in kidney function.

      Materials and methods

      The study population was derived from a series of consecutive patients presenting with stable angina pectoris or angina equivalents, who underwent coronary angiography. SYNTAX score for each patient was calculated to define severity of CAD. Change in kidney function was defined by calculating the rates of change in eGFR.


      Among the 823 patients included in our study, the mean age was 59.2 ± 10.7 years, 78.4% were males, and 32% had diabetes. The mean baseline eGFR was 87.3 ± 24.9 ml/min/1.73 m2 and the median Syntax score was 14 (IQR = 10–20). The median length of follow-up was 2.75 years (IQR = 2.42–3.50). The mean yearly change for eGFR in the entire study population was 4.06 (95% CI: 3.59–4.51) ml/min/1.73 m2. A higher Syntax score was associated with a significantly faster decline in eGFR in all (unadjusted and adjusted) models. During the follow-up, 103 patients developed CKD. A higher Syntax score, analyzed both as continuous and categorical variable, was associated with incident CKD in all models.


      We have demonstrated for the first time that severity of CAD is an independent risk factor for the decline in kidney function. Studies are needed to highlight the potential mechanisms regarding the association between severity of CAD and decline in kidney function.


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        • Bittencourt M.S.
        • Hulten E.A.
        • Ghoshhajra B.
        • Abbara S.
        • Murthy V.L.
        • Divakaran S.
        • et al.
        Incremental prognostic value of kidney function decline over coronary artery disease for cardiovascular event prediction after coronary computed tomography.
        Kidney Int. 2015; 88: 152-159
        • Foley R.N.
        • Parfrey P.S.
        • Sarnak M.J.
        Clinical epidemiology of cardiovascular disease in chronic renal disease.
        Am J Kidney Dis. 1998; 32: S112-S119
        • Drueke T.B.
        • Massy Z.A.
        Atherosclerosis in CKD: differences from the general population.
        Nat Rev Nephrol. 2010; 6: 723-735
        • Gibson C.M.
        • Dumaine R.L.
        • Gelfand E.V.
        • Murphy S.A.
        • Morrow D.A.
        • Wiviott S.D.
        • et al.
        Association of glomerular filtration rate on presentation with subsequent mortality in non-ST-segment elevation acute coronary syndrome; observations in 13,307 patients in five TIMI trials.
        Eur Heart J. 2004; 25: 1998-2005
        • Hillis G.S.
        • Croal B.L.
        • Buchan K.G.
        • El-Shafei H.
        • Gibson G.
        • Jeffrey R.R.
        • et al.
        Renal function and outcome from coronary artery bypass grafting: impact on mortality after a 2.3-year follow-up.
        Circulation. 2006; 113: 1056-1062
        • Inaguma D.
        • Tatematsu M.
        • Shinjo H.
        • Suzuki S.
        • Mishima T.
        • Inaba S.
        • et al.
        Relationship between renal function at the time of percutaneous coronary intervention and prognosis in ischemic heart disease patients.
        Clin Exp Nephrol. 2007; 11: 56-60
        • Rein P.
        • Saely C.H.
        • Vonbank A.
        • Boehnel C.
        • Drexel H.
        Usefulness of serial decline of kidney function to predict mortality and cardiovascular events in patients undergoing coronary angiography.
        Am J Cardiol. 2014; 113: 215-221
        • Tangri N.
        • Komenda P.V.
        • Rigatto C.
        Chronic kidney disease and heart disease: after 179 years, do we yet understand the link?.
        Kidney Int. 2015; 88: 11-13
        • Fihn S.D.
        • Gardin J.M.
        • Abrams J.
        • Berra K.
        • Blankenship J.C.
        • Dallas A.P.
        • et al.
        2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons.
        J Am Coll Cardiol. 2012; 60: e44-e164
        • Serruys P.W.
        • Morice M.C.
        • Kappetein A.P.
        • Colombo A.
        • Holmes D.R.
        • Mack M.J.
        • et al.
        Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease.
        N Engl J Med. 2009; 360: 961-972
        • Flack J.M.
        • Neaton J.D.
        • Daniels B.
        • Esunge P.
        Ethnicity and renal disease: lessons from the Multiple Risk Factor Intervention Trial and the Treatment of Mild Hypertension Study.
        Am J Kidney Dis. 1993; 21: 31-40
        • Ix J.H.
        • Mercado N.
        • Shlipak M.G.
        • Lemos P.A.
        • Boersma E.
        • Lindeboom W.
        • et al.
        Association of chronic kidney disease with clinical outcomes after coronary revascularization: the Arterial Revascularization Therapies Study (ARTS).
        Am Heart J. 2005; 149: 512-519
        • Blackman D.J.
        • Pinto R.
        • Ross J.R.
        • Seidelin P.H.
        • Ing D.
        • Jackevicius C.
        • et al.
        Impact of renal insufficiency on outcome after contemporary percutaneous coronary intervention.
        Am Heart J. 2006; 151: 146-152
        • Sarnak M.J.
        • Levey A.S.
        Cardiovascular disease and chronic renal disease: a new paradigm.
        Am J Kidney Dis. 2000; 35: S117-S131
        • Flack J.M.
        • Peters R.
        • Shafi T.
        • Alrefai H.
        • Nasser S.A.
        • Crook E.
        Prevention of hypertension and its complications: theoretical basis and guidelines for treatment.
        J Am Soc Nephrol. 2003; 14: S92-S98
        • Hostetter T.H.
        Prevention of the development and progression of renal disease.
        J Am Soc Nephrol. 2003; 14: S144-S147
        • Hostetter T.H.
        Chronic kidney disease predicts cardiovascular disease.
        N Engl J Med. 2004; 351: 1344-1346
        • Endemann D.H.
        • Schiffrin E.L.
        Endothelial dysfunction.
        J Am Soc Nephrol. 2004; 15: 1983-1992
        • Passauer J.
        • Pistrosch F.
        • Bussemaker E.
        • Lassig G.
        • Herbrig K.
        • Gross P.
        Reduced agonist-induced endothelium-dependent vasodilation in uremia is attributable to an impairment of vascular nitric oxide.
        J Am Soc Nephrol. 2005; 16: 959-965
        • Shivkar R.R.
        • Abhang S.A.
        Ratio of serum asymmetric dimethyl arginine (ADMA)/nitric oxide in coronary artery disease patients.
        J Clin Diagn Res. 2014; 8: CC04-CC06
        • Moreira D.M.
        • da Silva R.L.
        • Vieira J.L.
        • Fattah T.
        • Lueneberg M.E.
        • Gottschall C.A.
        Role of vascular inflammation in coronary artery disease: potential of anti-inflammatory drugs in the prevention of atherothrombosis. Inflammation and anti-inflammatory drugs in coronary artery disease.
        Am J Cardiovasc Drugs. 2015; 15: 1-11
        • Hashikata A.
        • Yamashita A.
        • Suzuki S.
        • Nagayasu S.
        • Shinjo T.
        • Taniguchi A.
        • et al.
        The inflammation-lipocalin 2 axis may contribute to the development of chronic kidney disease.
        Nephrol Dial Transplant. 2014; 29: 611-618
        • Ashfaq S.
        • Abramson J.L.
        • Jones D.P.
        • Rhodes S.D.
        • Weintraub W.S.
        • Hooper W.C.
        • et al.
        The relationship between plasma levels of oxidized and reduced thiols and early atherosclerosis in healthy adults.
        J Am Coll Cardiol. 2006; 47: 1005-1011
        • Mills B.J.
        • Weiss M.M.
        • Lang C.A.
        • Liu M.C.
        • Ziegler C.
        Blood glutathione and cysteine changes in cardiovascular disease.
        J Lab Clin Med. 2000; 135: 396-401
        • Tanaka H.
        • Komaba H.
        • Koizumi M.
        • Kakuta T.
        • Fukagawa M.
        Role of uremic toxins and oxidative stress in the development of chronic kidney disease-mineral and bone disorder.
        J Ren Nutr. 2012; 22: 98-101
        • Sureshbabu A.
        • Ryter S.W.
        • Choi M.E.
        Oxidative stress and autophagy: crucial modulators of kidney injury.
        Redox Biol. 2015; 4: 208-214