Relation between mild to moderate chronic kidney disease and coronary artery disease determined with coronary CT angiography.
BACKGROUND
Both end-stage and milder stages of chronic kidney disease (CKD) are associated with an increased risk of adverse cardiovascular events. Several studies found an association between decreasing renal function and increasing coronary artery calcification, but it remains unclear if this association is independent from traditional cardiovascular risk factors. Therefore, the aim of this study was to investigate whether mild to moderate CKD is independently associated with coronary plaque burden beyond traditional cardiovascular risk factors.


METHODS
A total of 2,038 patients with symptoms of chest discomfort suspected for coronary artery disease underwent coronary CT-angiography. We assessed traditional risk factors, coronary calcium score and coronary plaque characteristics (morphology and degree of luminal stenosis). Patients were subdivided in three groups, based on their estimated glomerular filtration rate (eGFR) Normal renal function (eGFR ≥90 mL/min/1.73 m(2)); mild CKD (eGFR 60-89 mL/min/1.73 m(2)); and moderate CKD (eGFR 30-59 mL/min/1.73 m(2)).


RESULTS
Coronary calcium score increased significantly with decreasing renal function (P<0.001). Coronary plaque prevalence was higher in patients with mild CKD (OR 1.83, 95%CI 1.52-2.21) and moderate CKD (OR 2.46, 95%CI 1.69-3.59), compared to patients with normal renal function (both P<0.001). Coronary plaques with >70% luminal stenosis were found significantly more often in patients with mild CKD (OR 1.67 (95%CI 1.16-2.40) and moderate CKD (OR2.36, 95%CI 1.35-4.13), compared to patients with normal renal function (both P<0.01). After adjustment for traditional cardiovascular risk factors, the association between renal function and the presence of any coronary plaque as well as the association between renal function and the presence of coronary plaques with >70% luminal stenosis becomes weaker and were no longer statistically significant.


CONCLUSIONS
Although decreasing renal function is associated with increasing extent and severity of coronary artery disease, mild to moderately CKD is not independently associated with coronary plaque burden after adjustment for traditional cardiovascular risk factors.
Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands. ivo.joosen@mumc.nl
Ivo A
IA
Joosen
Frank
F
Schiphof
Mathijs O
MO
Versteylen
Eduard M
EM
Laufer
Mark H
MH
Winkens
Patricia J
PJ
Nelemans
Jeroen P
JP
Kooman
Leonard
L
Hofstra
Joachim E
JE
Wildberger
Tim
T
Leiner
D017023:Coronary Angiography; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D051436:Renal Insufficiency, Chronic / Q000000981:diagnostic imaging* / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed