Association of atherosclerotic coronary artery disease and pulse pressure with renal disease progression.
BACKGROUND
This study was performed to identify the association of atherosclerotic coronary artery disease (CAD) and pulse pressure with renal disease progression in patients with mild chronic renal disease.


METHODS
Eligibility criteria for enrollment in this study included age 18 to 70 years, mild chronic renal disease (CRD), undergoing thallium SPECT and echocardiography and followed longer than three years. Mild CRD was defined as serum creatinine level of 1.5 to 3.0 mg/dL in men and 1.4 to 3.0 mg/dL in women. Patients with serious illness, history of kidney transplantation, ejection fraction less than 40% on echocardiography and development of acute renal failure during follow-up were excluded.


RESULTS
A total of 87 patients were included in this study. The underlying renal disease included diabetic nephropathy in 51 patients. Forty-five patients showed positive findings on thallium SPECT and they were classified as having CAD. Coronary angiography showed significant stenosis in 41 of 42 patients studied. Median duration of follow-up was 56 months. During the follow-up period, 40 patients required chronic dialysis therapy and 16 patients showed a doubling of baseline serum creatinine in three years. These 56 patients were classified as progressors. Comparison of clinical and laboratory parameters between progressors and nonprogressors showed a difference in the presence of diabetic nephropathy, mean arterial pressure, 24-h urine protein (p < 0.001), pulse pressure (p < 0.01), total cholesterol and presence of CAD (p < 0.05). There was no association between the progression of CRD and the results of CAD or treatment of CAD. Multivariate logistic regression analysis showed that the presence of diabetic nephropathy and mean arterial pressure > 100 mm Hg were independent predictors of CRD progression.


CONCLUSIONS
Atherosclerotic coronary artery disease and pulse pressure were associated with renal disease progression.
Kim
Soon Bae
SB
Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
Kwon
Soonkil
S
Lee
Sang Koo
SK
Park
Jung Sik
JS
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D001794:Blood Pressure; D015331:Cohort Studies; D015897:Comorbidity; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D018450:Disease Progression; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology*; D007677:Kidney Function Tests; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011336:Probability; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D015899:Tomography, Emission-Computed, Single-Photon