title: Low glomerular filtration rate and risk of myocardial infarction: A systematic review and meta-analysis.
abstract: BACKGROUND
  Chronic kidney disease is increasing in prevalence. The association between low baseline estimated glomerular filtration rate (eGFR) and future myocardial infarction has not been comprehensively assessed.
  
  
  METHODS
  A systematic review and meta-analysis of observational studies evaluating the risk for future myocardial infarction associated with eGFR <60 and 60-90ml/min/1.73m2was completed. Data sources included PubMed, EMBASE, and the Cochrane Library. Included studies were required to have prospectively collected data, followed subjects for at least 6months, and reported baseline eGFR levels and the multivariable-adjusted relative risk for future myocardial infarction. A random effects model was used and subgroup analyses were conducted.
  
  
  RESULTS
  26 publications representing 41 observational cohorts were selected. In total, 1,986,850 participants with more than 35,752 documented myocardial infarctions (follow-up range: 9months to ~20years) were evaluated. eGFR <60ml/min/1.73m2was associated with a relative risk of 1.52 (95% confidence interval 1.39-1.67; p<0.00001) while eGFR 60-90ml/min/1.73m2was associated with a relative risk of 1.21 (1.09-1.34; p=0.0002) for myocardial infarction. Significant heterogeneity existed among both eGFR groups. Subgroup analysis found a further increase in risk for myocardial infarction as eGFR declined from 30 to 60 to <30ml/min/1.73m2(1.40, 95% confidence interval, 1.21-1.61 vs.1.94, 95% confidence interval, 1.51-2.50; p=0.03).
  
  
  CONCLUSIONS
  Decreased baseline eGFR is independently associated with increased future myocardial infarction, and the risk increases with advanced renal insufficiency. Clinicians should be wary of acute coronary syndromes in patients with CKD.
authors.affiliation: Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA. Electronic address: vashisv@ccf.org.
authors.forename: Vishal
authors.initials: V
authors.lastname: Vashistha
authors.affiliation: Department of Neurology, Chang-Gung University College of Medicine, Chiayi, Taiwan. Electronic address: menglee5126@gmail.com.
authors.forename: Meng
authors.initials: M
authors.lastname: Lee
authors.affiliation: Department of Neurology, Chang-Gung University College of Medicine, Chiayi, Taiwan. Electronic address: wyling83@hotmail.com.
authors.forename: Yi-Ling
authors.initials: YL
authors.lastname: Wu
authors.affiliation: Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA. Electronic address: sukhdeep.bahad@gmail.com.
authors.forename: Sukhdeep
authors.initials: S
authors.lastname: Kaur
authors.affiliation: Department of Neurology and Neurosurgery, College of Medicine, Medical University of South Carolina, Charleston, SC, USA. Electronic address: ovibes@musc.edu.
authors.forename: Bruce
authors.initials: B
authors.lastname: Ovbiagele
mesh_terms: D014943:Global Health; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D015994:Incidence; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology*; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000503:physiopathology*; D012307:Risk Factors
keywords: Chronic kidney disease; Chronic renal insufficiency; Coronary artery disease; Myocardial infarction