Christiane Engelbertz1, Holger Reinecke1, Günter Breithardt1, Roland E Schmieder2, Manfred Fobker3, Dieter Fischer4, Boris Schmitz5, Hans O Pinnschmidt6, Karl Wegscheider6, Hermann Pavenstädt7, Eva Brand8. 1. Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany. 2. Department of Nephrology and Hypertension, University of Erlangen-Nuernberg, Erlangen, Germany. 3. Center of Laboratory Medicine, University Hospital Muenster, Muenster, Germany. 4. Division of Cardiology, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany. 5. Institute of Sports Medicine, Molecular Genetics of Cardiovascular Disease, University Hospital Muenster, Muenster, Germany. 6. Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany. 7. Department of Nephrology, Hypertension, and Rheumatology, University Hospital Muenster, Muenster, Germany. 8. Department of Nephrology, Hypertension, and Rheumatology, University Hospital Muenster, Muenster, Germany. Electronic address: eva.brand@ukmuenster.de.
Abstract
BACKGROUND: Chronic kidney disease (CKD) and coronary artery disease (CAD) are strongly associated. CAD is the most frequent cause of cardiovascular death in patients with CKD. METHODS: The prospective observational nationwide multicenter Coronary Artery Disease and REnal Failure (CAD-REF) Registry enrolled 3352 patients with angiographically documented CAD classified according to their baseline estimated glomerular filtration rate (eGFR) into 5 groups according to the K/DOQI-guidelines. Patients were followed for two years. The aim of this study was the analysis of outcome and the identification of risk factors for two-year mortality in patients with both CKD and CAD. RESULTS: With decreasing renal function, patients had more often diabetes mellitus, hypertension, peripheral artery disease, and previous cardiovascular events and interventions. The amount of diseased vessels increased with decreasing renal function. For the whole cohort, two-year mortality was 6.5%. Kaplan-Meier-curves showed highest mortality in patients with CKD stages 4 and 5 (22.4%). In multivariate Cox-regression analyses, significant risk factors for two-year all-cause mortality were lower eGFR, current smoking, left ventricular ejection fraction, diabetes mellitus treated with oral medication or insulin, age, and peripheral artery disease. Coronary status missed the level of statistical significance as a risk factor for mortality in multivariable regression analysis. An eGFR reduction of 10ml/min/1.73m2 increased the risk of mortality by 19% regardless of other risk factors. CONCLUSIONS: Two-year morbidity and mortality increased with the degree of renal impairment. To improve survival of patients with CAD and CKD, nephroprotection is urgently needed especially for patients with atherosclerotic burden. CLINICAL TRIAL REGISTRATION NUMBER: NCT00679419, http://clinicaltrials.gov/.
BACKGROUND:Chronic kidney disease (CKD) and coronary artery disease (CAD) are strongly associated. CAD is the most frequent cause of cardiovascular death in patients with CKD. METHODS: The prospective observational nationwide multicenter Coronary Artery Disease and REnal Failure (CAD-REF) Registry enrolled 3352 patients with angiographically documented CAD classified according to their baseline estimated glomerular filtration rate (eGFR) into 5 groups according to the K/DOQI-guidelines. Patients were followed for two years. The aim of this study was the analysis of outcome and the identification of risk factors for two-year mortality in patients with both CKD and CAD. RESULTS: With decreasing renal function, patients had more often diabetes mellitus, hypertension, peripheral artery disease, and previous cardiovascular events and interventions. The amount of diseased vessels increased with decreasing renal function. For the whole cohort, two-year mortality was 6.5%. Kaplan-Meier-curves showed highest mortality in patients with CKD stages 4 and 5 (22.4%). In multivariate Cox-regression analyses, significant risk factors for two-year all-cause mortality were lower eGFR, current smoking, left ventricular ejection fraction, diabetes mellitus treated with oral medication or insulin, age, and peripheral artery disease. Coronary status missed the level of statistical significance as a risk factor for mortality in multivariable regression analysis. An eGFR reduction of 10ml/min/1.73m2 increased the risk of mortality by 19% regardless of other risk factors. CONCLUSIONS: Two-year morbidity and mortality increased with the degree of renal impairment. To improve survival of patients with CAD and CKD, nephroprotection is urgently needed especially for patients with atherosclerotic burden. CLINICAL TRIAL REGISTRATION NUMBER: NCT00679419, http://clinicaltrials.gov/.
Authors: Boris Schmitz; Marcus E Kleber; Malte Lenders; Graciela E Delgado; Christiane Engelbertz; Jie Huang; Hermann Pavenstädt; Günter Breithardt; Stefan-Martin Brand; Winfried März; Eva Brand Journal: Sci Rep Date: 2019-02-26 Impact factor: 4.379
Authors: Maria Lukács Krogager; Regitze Kuhr Skals; Emil Vincent R Appel; Theresia M Schnurr; Line Engelbrechtsen; Christian Theil Have; Oluf Pedersen; Thomas Engstrøm; Dan M Roden; Gunnar Gislason; Henrik Enghusen Poulsen; Lars Køber; Steen Stender; Torben Hansen; Niels Grarup; Charlotte Andersson; Christian Torp-Pedersen; Peter E Weeke Journal: PLoS One Date: 2018-12-19 Impact factor: 3.240