The impact of normal range estimated glomerular filtration rate on mortality in selected patients undergoing coronary angiography - a long-term follow-up.
Acute Coronary Syndrome
/ epidemiology
Anemia
/ epidemiology
Angina, Stable
/ epidemiology
C-Reactive Protein
/ analysis
Coronary Angiography
Coronary Artery Bypass
Coronary Artery Disease
/ epidemiology
Female
Follow-Up Studies
Glomerular Filtration Rate
Humans
Israel
/ epidemiology
Leukocyte Count
Male
Middle Aged
Mortality
Myocardial Infarction
/ epidemiology
Registries
Journal
Coronary artery disease
ISSN: 1473-5830
Titre abrégé: Coron Artery Dis
Pays: England
ID NLM: 9011445
Informations de publication
Date de publication:
01 Jun 2021
01 Jun 2021
Historique:
pubmed:
25
11
2020
medline:
11
1
2022
entrez:
24
11
2020
Statut:
ppublish
Résumé
Estimated glomerular filtration rate (eGFR) predicts mortality and adverse cardiovascular events in people with chronic kidney disease. The significance of eGFR within the normal range and its long-term effect on clinical adverse events is unknown. We examined the effect of normal range or mildly reduced eGFR on long-term mortality in a large prospective registry. The study included consecutive patients undergoing clinically-driven coronary angiography who had an eGFR ≥60 ml/min/1.73 m2. Baseline clinical characteristics were assessed, and patients were followed-up for the occurrence of all-cause mortality. Cox regression analysis was used to evaluate the impact of eGFR. A total of 4186 patients were recruited. Median follow-up time was 2883 days (7.9 years). Mean age was 62.0 ± 11.3 years with 77.4% males. Clinical presentation included acute coronary syndrome and stable angina. In a multivariable model adjusted for possible confounding factors, decreasing eGFR within the normal and mildly reduced range was inversely associated with long-term all-cause mortality with a hazard ratio (HR) of 1.32 for every decrease of 10 ml/min/1.732 in eGFR. Compared to eGFR > 100 ml/min/1.732, there was a graded association between lower eGFR values and increased long term mortality with a HR of 1.16 (0.59-2.31) for eGFR 90-100 ml/min/1.732, HR 1.54 (0.81-2.91) for eGFR 80-90 ml/min/1.732, HR 2.62 (1.41-4.85) for eGFR 70-80 ml/min/1.732 and HR 2.93 (1.58-5.41) for eGFR 60-70 ml/min/1.732. eGFR within the normal and mildly reduced range is an independent predictor of long-term all-cause mortality in selected patients undergoing clinically driven coronary angiography.
Sections du résumé
BACKGROUND
BACKGROUND
Estimated glomerular filtration rate (eGFR) predicts mortality and adverse cardiovascular events in people with chronic kidney disease. The significance of eGFR within the normal range and its long-term effect on clinical adverse events is unknown. We examined the effect of normal range or mildly reduced eGFR on long-term mortality in a large prospective registry.
METHODS
METHODS
The study included consecutive patients undergoing clinically-driven coronary angiography who had an eGFR ≥60 ml/min/1.73 m2. Baseline clinical characteristics were assessed, and patients were followed-up for the occurrence of all-cause mortality. Cox regression analysis was used to evaluate the impact of eGFR.
RESULTS
RESULTS
A total of 4186 patients were recruited. Median follow-up time was 2883 days (7.9 years). Mean age was 62.0 ± 11.3 years with 77.4% males. Clinical presentation included acute coronary syndrome and stable angina. In a multivariable model adjusted for possible confounding factors, decreasing eGFR within the normal and mildly reduced range was inversely associated with long-term all-cause mortality with a hazard ratio (HR) of 1.32 for every decrease of 10 ml/min/1.732 in eGFR. Compared to eGFR > 100 ml/min/1.732, there was a graded association between lower eGFR values and increased long term mortality with a HR of 1.16 (0.59-2.31) for eGFR 90-100 ml/min/1.732, HR 1.54 (0.81-2.91) for eGFR 80-90 ml/min/1.732, HR 2.62 (1.41-4.85) for eGFR 70-80 ml/min/1.732 and HR 2.93 (1.58-5.41) for eGFR 60-70 ml/min/1.732.
CONCLUSION
CONCLUSIONS
eGFR within the normal and mildly reduced range is an independent predictor of long-term all-cause mortality in selected patients undergoing clinically driven coronary angiography.
Identifiants
pubmed: 33229938
pii: 00019501-202106000-00006
doi: 10.1097/MCA.0000000000000985
doi:
Substances chimiques
C-Reactive Protein
9007-41-4
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
302-308Informations de copyright
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Références
Baber U, Farkouh ME, Arbel Y, Muntner P, Dangas G, Mack MJ, et al. Comparative efficacy of coronary artery bypass surgery vs. percutaneous coronary intervention in patients with diabetes and multivessel coronary artery disease with or without chronic kidney disease. Eur Heart J. 2016; 37:3440–3447.
Currie CJ, Berni ER, Berni TR, Jenkins-Jones S, Sinsakul M, Jermutus L, et al. Major adverse cardiovascular events in people with chronic kidney disease in relation to disease severity and diabetes status. PLoS One. 2019; 14:e0221044.
Manjunath G, Tighiouart H, Ibrahim H, MacLeod B, Salem DN, Griffith JL, et al. Level of kidney function as a risk factor for atherosclerotic cardiovascular outcomes in the community. J Am Coll Cardiol. 2003; 41:47–55.
Arbel Y, Halkin A, Finkelstein A, Revivo M, Berliner S, Herz I, et al., Impact of estimated glomerular filtration rate on vascular disease extent and adverse cardiovascular events in patients without chronic kidney disease. Can J Cardiol. 2013: 29:1374–1381.
von Scholten BJ, Hansen TW, Goetze JP, Persson F, Rossing P. Glucagon-like peptide 1 receptor agonist (GLP-1 RA): long-term effect on kidney function in patients with type 2 diabetes. J Diabetes Complications. 2015; 29:670–674.
Mann JF, Schmieder RE, McQueen M, Dyal L, Schumacher H, Pogue J, et al.; ONTARGET investigators. Renal outcomes with telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study): a multicentre, randomised, double-blind, controlled trial. Lancet. 2008; 372:547–553.
Neuen BL, Young T, Heerspink HJL, Neal B, Perkovic V, Billot L, et al. SGLT2 inhibitors for the prevention of kidney failure in patients with type 2 diabetes: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 2019; 7:845–854.
Arbel Y, Zlotnik M, Halkin A, Havakuk O, Berliner S, Herz I, et al. Admission glucose, fasting glucose, HbA1c levels and the SYNTAX score in non-diabetic patients undergoing coronary angiography. Clin Res Cardiol. 2014; 103:223–227.
Havakuk O, Banai S, Halkin A, Konigstein M, Ben Assa E, Berliner S, et al. HbA1c levels and long-term mortality in patients undergoing coronary angiography. Cardiology. 2016; 134:101–106.
Shenhar-Tsarfaty S, Brzezinski RY, Waiskopf N, Finkelstein A, Halkin A, Berliner S, et al. Blood acetylcholinesterase activity is associated with increased 10 year all-cause mortality following coronary angiography. Atherosclerosis. 2020; 313:144–149.
Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al.; CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009; 150:604–612.
International Society of Nephrology. Notice. Kidney Int Suppl. 2013:3:1. https://kdigo.org/wp-content/uploads/2017/02/KDIGO_2012_CKD_GL.pdf .
Guo Y, Cui L, Ye P, Li J, Wu S, Luo Y. Change of kidney function is associated with all-cause mortality and cardiovascular diseases: results from the Kailuan Study. J Am Heart Assoc. 2018: 7:e010596.
Rozenbaum Z, Ben-Bassat OK, Hadad Y, Iluz M, Granot Y, Ziv-Baran T, et al. Left atrial volume as a biomarker of target organ damage in cardionephrology: a study in a wide range of renal function. Chest. 2018; 154:893–903.
Gansevoort RT, Correa-Rotter R, Hemmelgarn BR, Jafar TH, Heerspink HJ, Mann JF, et al. Chronic kidney disease and cardiovascular risk: epidemiology, mechanisms, and prevention. Lancet. 2013; 382:339–352.
Parikh NI, Hwang SJ, Larson MG, Meigs JB, Levy D, Fox CS. Cardiovascular disease risk factors in chronic kidney disease: overall burden and rates of treatment and control. Arch Intern Med. 2006; 166:1884–1891.
McMahon EJ, Bauer JD, Hawley CM, Isbel NM, Stowasser M, Johnson DW, Campbell KL. A randomized trial of dietary sodium restriction in CKD. J Am Soc Nephrol. 2013; 24:2096–2103.
Johansen KL, Painter P. Exercise in individuals with CKD. Am J Kidney Dis. 2012: 59:126–134.
Jafar TH, Schmid CH, Landa M, Giatras I, Toto R, Remuzzi G, et al. Angiotensin-converting enzyme inhibitors and progression of nondiabetic renal disease. A meta-analysis of patient-level data. Ann Intern Med. 2001; 135:73–87.
Cheng J, Zhang W, Zhang X, Han F, Li X, He X, et al. Effect of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on all-cause mortality, cardiovascular deaths, and cardiovascular events in patients with diabetes mellitus: a meta-analysis. JAMA Intern Med. 2014; 174:773–785.
Wang K, Hu J, Luo T, Wang Y, Yang S, Qing H, et al. Effects of angiotensin-converting enzyme inhibitors and angiotensin ii receptor blockers on all-cause mortality and renal outcomes in patients with diabetes and albuminuria: a systematic review and meta-analysis. Kidney Blood Press Res. 2018; 43:768–779.
Cholesterol Treatment Trialists’ (CTT) Collaboration; Baigent C, Blackwell L, Emberson J, Holland LE, Reith C, Bhala N, et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet. 2010: 376:1670–1681.
Mills EJ, O’Regan C, Eyawo O, Wu P, Mills F, Berwanger O, Briel M. Intensive statin therapy compared with moderate dosing for prevention of cardiovascular events: a meta-analysis of >40 000 patients. Eur Heart J. 2011; 32:1409–1415.
Berger JS, Brown DL, Becker RC. Low-dose aspirin in patients with stable cardiovascular disease: a meta-analysis. Am J Med. 2008; 121:43–49.