Chronic kidney disease is associated with angiographic coronary artery disease.
OBJECTIVE
Patients with chronic kidney disease (CKD) have a dramatically increased risk for cardiovascular mortality. Few prior studies have examined the independent association of CKD with coronary anatomy.


METHODS
We evaluated the relationship between CKD and severe coronary artery disease (CAD) in 261 male veterans with nuclear perfusion imaging tests suggesting coronary ischemia. We used chart review and patient and provider interviews to collect demographics, clinical characteristics, and coronary anatomy results. We defined CKD as an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2, based on the creatinine obtained prior to angiography. We defined significant coronary obstruction as at least one 70% or greater stenosis. We used logistic regression to determine whether CKD was independently associated with significant coronary obstruction.


RESULTS
The likelihood of CAD increased monotonically with decreasing eGFR, from 51% among patients with eGFR or = 90 ml/min/1.73 m2 to 84% in those with eGFR < 30 ml/min/1.73 m2 (p = 0.0046). Patients with CKD were more likely than those without CKD to have at least one significant coronary obstruction (75.9 vs. 60.7%, p = 0.016). Patients with CKD also had more significant CAD, that is, were more likely to have three-vessel and/or left main disease than those without CKD (34.9 vs. 16.9%, p = 0.0035). In logistic regression analysis, controlling for demographics and comorbidity, CKD continued to be independently associated with the presence of significant CAD (p = 0.0071).


CONCLUSIONS
CKD patients have a high prevalence of obstructive coronary disease, which may contribute to their high cardiovascular mortality.
Chonchol
Michel
M
Division of Renal Diseases and Hypertension, University of Colorado Health Sciences Center, Denver, Colo. 80262, USA. Michel.Chonchol@uchsc.edu
Whittle
Jeff
J
Desbien
Angela
A
Orner
Michelle B
MB
Petersen
Laura A
LA
Kressin
Nancy R
NR
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications*; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009398:Nephrology / Q000379:methods*