Impact of mild to moderate reductions of glomerular filtration rate on coronary artery disease severity.
OBJECTIVE
The bases of the link between reduced glomerular filtration rate (GFR) and coronary artery disease (CAD) are complex and to some extent still unclear. We performed this observational, single referral center, cohort study to evaluate whether mild to moderate GFR reduction is associated with more severe CAD and/or with a worse cardiac prognosis independently of proteinuria, diabetes and traditional risk factors.


RESULTS
In 1752 consecutive non-diabetic patients without proteinuria or moderate/severe kidney disease undergoing a clinically driven coronary angiography, coronary arteries lesions, myocardial function and hypertrophy and 10-yrs incidence of cardiac events and death were evaluated in relation to classes of estimated GFR defined according the lowest eGFR value (105+, 90+, 75+, 60+, 45+). A reduced eGFR was independently associated with hypertension, myocardial hypertrophy and stress induced ischemia, while the excess coronary lesions and the worse myocardial systolic function were both largely explained by age and cardiovascular risk factors. When compared to subjects 75+, both the risk of cardiac death (1.67[1.10-2.57] and 3.06[1.85-5.10]) and non-fatal myocardial infarction (2.58[1.12-6.49] and 2.73[1.31-6.41]) adjusted for age and comorbidities were higher in eGFR 60+ and 45+ patients.


CONCLUSIONS
A mild-moderate reduction of eGFR is closely associated to higher rates of stress-induced ischemia, myocardial hypertrophy and higher risk of fatal and non-fatal cardiac events. The associations of reduced eGFR with coronary atherosclerosis and myocardial systolic dysfunction are both largely explained by age and traditional risk factors.
Department of Clinical and Experimental Medicine, University of Pisa School of Medicine, Pisa, Italy. Electronic address: andrea.natali@med.unipi.
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Natali
Department of Clinical and Experimental Medicine, University of Pisa School of Medicine, Pisa, Italy.
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Boldrini
Department of Clinical and Experimental Medicine, University of Pisa School of Medicine, Pisa, Italy.
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Baldi
Department of Clinical and Experimental Medicine, University of Pisa School of Medicine, Pisa, Italy.
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Rossi
C.N.R. Institute of Clinical Physiology, Pisa, Italy.
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Landi
Grosseto Hospital, Grosseto, Italy.
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Severi
Department of Clinical and Experimental Medicine, University of Pisa School of Medicine, Pisa, Italy.
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Solini
Department of Clinical and Experimental Medicine, University of Pisa School of Medicine, Pisa, Italy.
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Ferrannini
D000328:Adult; D002312:Cardiomyopathy, Hypertrophic / Q000453:epidemiology / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D015331:Cohort Studies; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009026:Mortality; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D015995:Prevalence; D051437:Renal Insufficiency / Q000503:physiopathology*; D012720:Severity of Illness Index; D016019:Survival Analysis
Cardiac death; Chronic kidney disease; Coronary angiography; Coronary atherosclerosis; Kidney dysfunction