Association of kidney function with coronary atherosclerosis and calcification in autopsy samples from Japanese elders: the Hisayama study.
BACKGROUND
Chronic kidney disease (CKD) is associated with increased risk of coronary heart disease. However, information regarding the histopathologic characteristics of coronary atherosclerosis in individuals with CKD is scarce. This study investigated the relationship between CKD and severity of coronary atherosclerosis in population-based autopsy samples.


METHODS
Cross-sectional study.


METHODS
126 individuals randomly selected from 844 consecutive population-based autopsy samples.


METHODS
Estimated glomerular filtration rate (eGFR) calculated using the 6-variable Modification of Diet in Renal Disease (MDRD) Study equation.


RESULTS
Severity of atherosclerosis in 3 main coronary arteries, including atherosclerotic lesion types defined using the American Heart Association classification; stenosis rates; and coronary calcified lesions.


METHODS
The relationship between CKD and severity of coronary atherosclerosis was evaluated using generalized estimating equation methods.


RESULTS
Frequencies of advanced atherosclerotic lesions increased gradually as eGFR decreased (33.6%, 41.7%, 52.3%, and 52.8% for eGFRs > or = 60, 45-59, 30-44, and <30 mL/min/1.73 m(2), respectively; P for trend = 0.006). This relationship was substantially unchanged even after adjustment for potential confounding factors (ORs, 1.40 [95% CI, 0.76-2.55], 2.02 [95% CI, 0.99-4.15], and 3.02 [95% CI, 1.22-7.49] for eGFRs of 45-59, 30-44, and <30 mL/min/1.73 m(2), respectively). Frequencies of calcified lesions of coronary arteries also increased gradually with lower eGFRs (P for trend = 0.02). Hypertension and diabetes were associated with increased risk of advanced coronary atherosclerosis and calcification of coronary arteries in individuals with decreased eGFR.


CONCLUSIONS
Cross-sectional study, absence of data for proteinuria, and extremely high proportion of aged people.


CONCLUSIONS
The autopsy findings presented here suggest that CKD is associated significantly with severity of coronary atherosclerosis. Patients with CKD should be considered a high-risk population for advanced coronary atherosclerosis.
Nakano
Toshiaki
T
Pathophysiological and Experimental Pathology, Department of Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan. toshink@med.kyushu-u.ac.jp
Ninomiya
Toshiharu
T
Sumiyoshi
Shinji
S
Fujii
Hiroshi
H
Doi
Yasufumi
Y
Hirakata
Hideki
H
Tsuruya
Kazuhiko
K
Iida
Mitsuo
M
Kiyohara
Yutaka
Y
Sueishi
Katsuo
K
D000367:Age Factors; D000369:Aged, 80 and over; D001344:Autopsy; D002114:Calcinosis / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D009202:Cardiomyopathies / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D003430:Cross-Sectional Studies; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D007668:Kidney / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000453:epidemiology; D008297:Male; D012307:Risk Factors; D012720:Severity of Illness Index