Impact of chronic kidney disease on postinfarction inflammation, oxidative stress, and left ventricular remodeling.
BACKGROUND
Patients with chronic kidney disease (CKD) have poor clinical outcomes after myocardial infarction (MI). However, the precise mechanisms are unclear. We sought to determine the prognostic significance of CKD in patients with MI in relation to left ventricular (LV) remodeling.


RESULTS
We examined 120 consecutive patients with a reperfused first anterior ST-elevation MI. Patients were divided into 2 groups according to the presence or absence of CKD, defined as estimated glomerular filtration rates <60 mL x min x 1.73 m2. Patients with CKD had a higher incidence of in-hospital cardiac death and readmission for heart failure during follow-up, in association with a greater LV volume and lower LV ejection fraction 2 weeks after MI compared with those without CKD. Cox proportional hazards model analysis revealed that CKD was an independent predictor of major adverse cardiac events (hazard ratio=3.13, P=.001). Plasma interleukin-6 on admission, and peak serum C-reactive protein, and malondialdehyde-modified low-density lipoprotein levels during convalescence, were higher in patients with CKD than in those without.


CONCLUSIONS
Patients with CKD had poorer clinical outcomes and accelerated infarct expansion in association with enhanced inflammation and oxidative stress, as compared with non-CKD patients, suggesting a major impact of CKD in the development of LV remodeling after MI.
Naito
Kotaro
K
Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
Anzai
Toshihisa
T
Yoshikawa
Tsutomu
T
Anzai
Atsushi
A
Kaneko
Hidehiro
H
Kohno
Takashi
T
Takahashi
Toshiyuki
T
Kawamura
Akio
A
Ogawa
Satoshi
S
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology; D006760:Hospitalization / Q000639:trends; D006801:Humans; D007249:Inflammation / Q000209:etiology / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000503:physiopathology*; D018384:Oxidative Stress / Q000502:physiology*; D012307:Risk Factors; D020257:Ventricular Remodeling / Q000502:physiology*