title: Renal function and coronary microvascular dysfunction in women with symptoms/signs of ischemia.
abstract: OBJECTIVE
  Chronic kidney disease (CKD) is more prevalent among women and is associated with adverse cardiovascular events. Among women with symptoms and signs of ischemia enrolled in the Women's Ischemia Syndrome Evaluation (WISE), a relatively high mortality rate was observed in those with no obstructive coronary artery disease. Coronary microvascular dysfunction or reduced coronary flow reserve (CFR) was a strong and independent predictor of adverse outcomes. The objective of this analysis was to determine if renal function was associated with coronary microvascular dysfunction in women with signs and symptoms of ischemia.
  
  
  METHODS
  The WISE was a multicenter, prospective, cohort study of women undergoing coronary angiography for suspected ischemia. Among 198 women with additional measurements of CFR, we determined the estimated glomerular filtration rate (eGFR) with the CKD-EPI equation. We tested the association between eGFR and CFR with regression analysis.
  
  
  RESULTS
  The median eGFR was 89 ml/min. The eGFR correlated with CFR (r = 0.22; P = 0.002). This association persisted even after covariate adjustment. Each 10-unit decrease in eGFR was associated with a 0.04-unit decrease in CFR (P = 0.04).There was a strong interaction between eGFR and age (P = 0.006): in those ≥60 years old, GFR was strongly correlated with CFR (r = 0.55; P<0.0001). No significant correlation was noted in those <60 years old.
  
  
  CONCLUSIONS
  Reduced renal function was significantly associated with lower CFR in women with symptoms and signs of ischemia. Coronary microvascular dysfunction warrants additional study as a mechanism contributing to increased risk of cardiovascular events in CKD.
authors.affiliation: Nephrology and Hypertension Section, North Florida/South Georgia Veterans Health System, Gainesville, Florida, United States of America; Division of Nephrology, Hypertension & Transplantation, University of Florida, Gainesville, Florida, United States of America.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Mohandas
authors.affiliation: Nephrology and Hypertension Section, North Florida/South Georgia Veterans Health System, Gainesville, Florida, United States of America; Division of Nephrology, Hypertension & Transplantation, University of Florida, Gainesville, Florida, United States of America.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Segal
authors.affiliation: Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, United States of America.
authors.forename: Tianyao
authors.initials: T
authors.lastname: Huo
authors.affiliation: Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, United States of America.
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Handberg
authors.affiliation: Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, United States of America.
authors.forename: John W
authors.initials: JW
authors.lastname: Petersen
authors.affiliation: University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.
authors.forename: B Delia
authors.initials: BD
authors.lastname: Johnson
authors.affiliation: National Institutes of Health, Bethesda, Maryland, United States of America.
authors.forename: George
authors.initials: G
authors.lastname: Sopko
authors.affiliation: Barbra Streisand Women's Heart Center, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.
authors.forename: C Noel
authors.initials: CN
authors.lastname: Bairey Merz
authors.affiliation: Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, United States of America.
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Pepine
mesh_terms: D000328:Adult; D000368:Aged; D017023:Coronary Angiography; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D005919:Glomerular Filtration Rate; D006801:Humans; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000503:physiopathology; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000503:physiopathology*