Mild renal dysfunction and long-term adverse outcomes in women with chest pain: results from the National Heart, Lung, and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation (WISE).
BACKGROUND
Chronic kidney disease (CKD) is associated with accelerated atherosclerosis and adverse cardiovascular outcomes, but mechanisms are unclear. We hypothesized that mild CKD independently predicts adverse outcomes in women with symptoms and signs of ischemia.


METHODS
We categorized 876 women from the Women's Ischemia Syndrome Evaluation cohort according to estimated glomerular filtration rate (eGFR) (eGFR ≥90 mL/min per 1.73 m(2) [normal], 60-89 mL/min per 1.73 m(2) [mild CKD], ≤59 mL/min per 1.73 m(2) [severe CKD]). Time to death from all-cause and cardiovascular causes and major adverse outcomes were assessed by multivariate regression adjusted for baseline covariates.


RESULTS
Obstructive coronary artery disease (CAD) was present only in few patients (39%). Even after adjusting for CAD severity, renal function remained a strong independent predictor of all-cause and cardiac mortality (P < .001). Every 10-unit decrease in eGFR was associated with a 14% increased risk of all-cause mortality (adjusted hazard ratio [AHR] 1.14 [1.08-1.20], P < .0001), 16% increased risk of cardiovascular mortality (AHR 1.16 [1.09-1.23], P < .0001), and 9% increased risk of adverse cardiovascular events (AHR 1.09 [1.03-1.15], P = .002).


CONCLUSIONS
Even mild CKD is a strong independent predictor of all-cause and cardiac mortality in women with symptoms/signs of ischemia, regardless of underlying obstructive CAD severity, underscoring the need to better understand the interactions between ischemic heart disease and CKD.
Division of Nephrology, Hypertension, and Transplantation, University of Florida, Gainesville, FL; Nephrology and Hypertension Section, North Florida/South Georgia Veterans Health System, Gainesville, FL.
Rajesh
R
Mohandas
Division of Nephrology, Hypertension, and Transplantation, University of Florida, Gainesville, FL; Nephrology and Hypertension Section, North Florida/South Georgia Veterans Health System, Gainesville, FL.
Mark
M
Segal
Division of Nephrology, Hypertension, and Transplantation, University of Florida, Gainesville, FL; Medical University of South Carolina, Charleston, SC.
Titte R
TR
Srinivas
University of Pittsburgh, Pittsburgh, PA.
B Delia
BD
Johnson
Division of Nephrology, Hypertension, and Transplantation, University of Florida, Gainesville, FL.
Xuerong
X
Wen
Division of Cardiovascular Medicine, University of Florida, Gainesville, FL.
Eileen M
EM
Handberg
Division of Cardiovascular Medicine, University of Florida, Gainesville, FL.
John W
JW
Petersen
National Institutes of Health, Bethesda, MD.
George
G
Sopko
Barbra Streisand Women's Heart Center, Cedars-Sinai Medical Center, Los Angeles, CA.
C Noel Bairey
CN
Merz
Division of Cardiovascular Medicine, University of Florida, Gainesville, FL. Electronic address: Carl.Pepine@medicine.ufl.edu.
Carl J
CJ
Pepine
D000368:Aged; D002637:Chest Pain / Q000401:mortality* / Q000503:physiopathology*; D003324:Coronary Artery Disease / Q000401:mortality / Q000503:physiopathology; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology*; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000401:mortality* / Q000503:physiopathology*; D051437:Renal Insufficiency / Q000503:physiopathology*; D018570:Risk Assessment; D012720:Severity of Illness Index; D016387:Women's Health