Advertisement

Impact of eGFR rate on 1-year all-cause mortality in patients with stable coronary artery disease

      Highlights

      • The prognostic impact of different degree of estimated glomerular filtration rate (eGFR) reduction in patients with stable coronary artery disease (CAD) is poorly studied.
      • We studied 4,130 patients with stable CAD recruited in a prospective, observational, nationwide study in Italy.
      • Baseline management and all-cause 1-year mortality were evaluated according to groups of eGFR (<30; 30-59; 60-89; ≥90 ml/min/1.73 m2).
      • Progressively lower eGFR significantly correlated with all-cause 1-year mortality

      Abstract

      Background

      Coronary artery disease (CAD) is a leading cause of mortality and is often complicated by chronic kidney disease. We sought to investigate the prevalence of different degree of estimated glomerular filtration rate (eGFR) reduction, the clinical and bio-humoral correlates, its relationship with therapeutic management, and its predictive role on 1-year all-cause mortality, in patients with stable CAD.

      Methods

      We studied 4,130 patients with stable CAD recruited in a prospective, observational, nationwide study (START, STable coronary Artery diseases RegisTry) in Italy. Baseline clinical characteristics, pharmacological treatment, and all-cause 1-year mortality were evaluated according to groups of eGFR (<30; 30-59; 60-89; ≥90 ml/min/1.73 m2) at baseline.

      Results

      The presence and the degree of chronic kidney disease entailed an unfavorable risk profile, since it was gradually associated with more comorbidities. Furthermore, progressively lower eGFR values were associated to lower diastolic blood pressure and hemoglobin values. As eGFR lowers, optimal medical treatment and its persistence overtime is reduced. Multivariate analysis showed that progressively lower eGFR significantly correlated with all-cause 1-year mortality [hazard ratio (HR): 1.02; 95% confidence intervals (CI): 1.01-1-03; p = 0.0001].

      Conclusions

      Low eGFR is associated with an increasing risk of all-cause mortality in patients with stable CAD. Chronic kidney disease may hamper the optimization of treatment limiting the use of drugs which may favorably impact cardiovascular and renal outcomes.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to European Journal of Internal Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Jha V.
        • Garcia-Garcia G.
        • Iseki K.
        • et al.
        Chronic kidney disease: global dimension and perspectives.
        Lancet. 2013; 382: 260-272
        • GBD Chronic Kidney Disease Collaboration
        Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of disease study 2017.
        Lancet. 2020; 395: 709-733
        • Stevens PE
        • Levin A
        • Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members
        Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline.
        Ann Intern Med. 2013; 158: 825-830
        • Murton M.
        • Goff-Leggett D.
        • Bobrowska A.
        • et al.
        Burden of chronic kidney disease by KDIGO categories of glomerular filtration rate and albuminuria: a systematic review.
        Adv Ther. 2021; 38: 180-200
        • Sarnak M.J.
        • Amann K.
        • Bangalore S.
        • et al.
        Chronic kidney disease and coronary artery disease: JACC state-of-the-art review.
        J Am Coll Cardiol. 2019; 74: 1823-1838
        • Tonelli M.
        • Muntner P.
        • Lloyd A.
        • et al.
        Alberta kidney disease network. Risk of coronary events in people with chronic kidney disease compared with those with diabetes: a population-level cohort study.
        Lancet. 2012; 380: 807-814
        • Go A.S.
        • Chertow G.M.
        • Fan D.
        • McCulloch C.E.
        • Hsu C.Y.
        Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization.
        N Engl J Med. 2004; 351: 1296-1305
        • Go A.S.
        • Bansal N.
        • Chandra M.
        • et al.
        ADVANCE study investigators. Chronic kidney disease and risk for presenting with acute myocardial infarction versus stable exertional angina in adults with coronary heart disease.
        J Am Coll Cardiol. 2011; 58: 1600-1607
        • De Luca L.
        • Di Pasquale G.
        • Gonzini L.
        • et al.
        Temporal trends in invasive management and in-hospital mortality of patients with non-ST elevation acute coronary syndromes and chronic kidney disease.
        Angiology. 2021; 72: 236-243
        • Chen J.
        • Budoff M.J.
        • Reilly M.P.
        • CRIC Investigators
        Coronary artery calcification and risk of cardiovascular disease and death among patients with chronic kidney disease.
        JAMA Cardiol. 2017; 2: 635-643
        • Matsushita K.
        • van der Velde M.
        • Astor B.C.
        • et al.
        • Chronic Kidney Disease Prognosis Consortium
        Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis.
        Lancet. 2010; 375: 2073-2081
        • Joosen I.A.
        • Schiphof F.
        • Versteylen M.O.
        • et al.
        Relation between mild to moderate chronic kidney disease and coronary artery disease determined with coronary CT angiography.
        PLoS One. 2012; 7: e47267
        • Anavekar N.S.
        • McMurray J.J.
        • Velazquez E.J.
        • et al.
        Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction.
        N Engl J Med. 2004; 351: 1285-1295
        • Bundy J.D.
        • Chen J.
        • Yang W.
        • for the CRIC Study Investigators
        Risk factors for progression of coronary artery calcification in patients with chronic kidney disease: the CRIC study.
        Atherosclerosis. 2018; 271: 53-60
        • Sedlis S.P.
        • Jurkovitz C.T.
        • Hartigan P.M.
        • COURAGE Study Investigators
        Optimal medical therapy with or without percutaneous coronary intervention for patients with stable coronary artery disease and chronic kidney disease.
        Am J Cardiol. 2009; 104: 1647-1653
        • Kalra P.R.
        • García-Moll X.
        • Zamorano J.
        • CLARIFY Investigators
        Impact of chronic kidney disease on use of evidence-based therapy in stable coronary artery disease: a prospective analysis of 22,272 patients.
        PLoS One. 2014; 9e102335
        • De Luca L.
        • Temporelli P.L.
        • Lucci D.
        • START Investigators
        Current management and treatment of patients with stable coronary artery diseases presenting to cardiologists in different clinical contexts: a prospective, observational, nationwide study.
        Eur J Prev Cardiol. 2018; 25: 43-53
        • De Luca L.
        • Temporelli P.L.
        • Riccio C.
        • START Investigators
        Clinical outcomes, pharmacological treatment, and quality of life of patients with stable coronary artery diseases managed by cardiologists: 1-year results of the START study.
        Eur Heart J Qual Care Clin Outcomes. 2019; 5: 334-342
        • Knuuti J.
        • Wijns W.
        • Saraste A.
        • et al.
        ESC scientific document group. 2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes.
        Eur Heart J. 2020; 41: 407-477
        • Fihn S.D.
        • Blankenship J.C.
        • Alexander K.P.
        • et al.
        2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons.
        Circulation. 2014; 130: 1749-1767
        • Levey A.S.
        • Bosch J.P.
        • Lewis J.B.
        • Greene T.
        • Rogers N.
        • Roth D.
        A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of diet in Renal Disease Study Group.
        Ann Intern Med. 1999; 130: 461-470
        • Lin M.J.
        • Yang W.C.
        • Chen C.Y.
        • et al.
        Hypertension and chronic kidney disease affect long-term outcomes in patients with stable coronary artery disease receiving percutaneous coronary intervention.
        Sci Rep. 2018; 8: 17673
        • Nakamura M.
        • Yamashita T.
        • Yajima J.
        • et al.
        Impact of reduced renal function on prognosis in Japanese patients with coronary artery disease: a prospective cohort of Shinken database 2007.
        Hypertens Res. 2009; 32: 920-926
        • Lima E.G.
        • Charytan D.M.
        • Hueb W.
        • et al.
        Long-term outcomes of patients with stable coronary disease and chronic kidney dysfunction: 10-year follow-up of the medicine, angioplasty, or surgery study II trial.
        Nephrol Dial Transplant. 2020; 35: 1369-1376
        • Matsushita K.
        • Coresh J.
        • Sang Y.
        • et al.
        Estimated glomerular filtration rate and albuminuria for prediction of cardiovascular outcomes: a collaborative meta-analysis of individual participant data.
        Lancet Diabetes Endocrinol. 2015; 3: 514-525
        • Epstein M.
        • Reaven N.L.
        • Funk S.E.
        • et al.
        Evaluation of the treatment gap between clinical guidelines and the utilization of renin-angiotensin-aldosterone system inhibitors.
        Am J Manag Care. 2015; 21: S212-S220
        • Qiao Y.
        • Shin J.I.
        • Sang Y.
        • et al.
        Discontinuation of angiotensin converting enzyme inhibitors and angiotensin receptor blockers in chronic kidney disease.
        Mayo Clin Proc. 2019; 94: 2220-2229
        • Ku E.
        • McCulloch C.E.
        • Vittinghoff E.
        • Lin F.
        • Johansen K.L.
        Use of antihypertensive agents and association with risk of adverse outcomes in chronic kidney disease: Focus on angiotensin-converting enzyme inhibitors and angiotensin receptor blockers.
        J Am Heart Assoc. 2018; 7e009992
        • Fu E.L.
        • Clase C.M.
        • Evans M.
        • et al.
        Comparative effectiveness of renin-angiotensin system inhibitors and calcium channel blockers in individuals with advanced CKD: a nationwide observational cohort study.
        Am J Kidney Dis. 2021; 77: 719-729
        • Fu E.L.
        • Evans M.
        • Clase C.M.
        • et al.
        Stopping renin-angiotensin system inhibitors in patients with advanced CKD and risk of adverse outcomes: a nationwide study.
        J Am Soc Nephrol. 2021; 32: 424-435
        • Arif H.
        • Yadav A.
        Approach to stable angina in patients with advanced chronic kidney disease.
        Curr Opin Nephrol Hypertens. 2021; 30: 339-345
        • Bangalore S.
        • Maron D.J.
        • O'Brien S.M.
        • et al.
        Management of coronary disease in patients with advanced kidney disease.
        New Engl J Med. 2020; 382: 1608-1618
        • Spertus J.A.
        • Jones P.G.
        • Maron D.J.
        • et al.
        Health status after invasive or conservative care in coronary and advanced kidney disease.
        New Engl J Med. 2020; 382: 1619-1628
        • Karimi G.K.
        • Chadban S.
        • Mehran R.
        • Bangalore S.
        • Chertow G.M.
        • Ali Z.A.
        Invasive management of coronary artery disease in advanced renal disease.
        Kidney Int Rep. 2021; 6: 1513-1524
        • Coiro S.
        • Girerd N.
        • Sharma A.
        • et al.
        Association of diabetes and kidney function according to age and systolic function with the incidence of sudden cardiac death and non-sudden cardiac death in myocardial infarction survivors with heart failure.
        Eur J Heart Fail. 2019; 21: 1248-1258