Estimated Glomerular Filtration Rate and Mortality among Patients with Coronary Heart Disease

Abstract

ObjectiveThe association between estimated glomerular filtration rate (eGFR) and the risk of mortality among patients with coronary heart disease (CHD) is complex and still unclear. The aim of this study was to evaluate the effect of eGFR on the risk prediction of all-cause and cardiovascular disease (CVD) mortality with a long follow-up period among patients with CHD in China.MethodsWe conducted a prospective cohort study of 3276 Chinese patients with CHD. Cox proportional hazards regression models were used to estimate the association of different levels of eGFR with the risks of mortality.ResultsDuring a mean follow-up period of 4.9 years, 293 deaths were identified. The multivariable-adjusted hazard ratios associated with different levels of eGFR (≥90 [reference group], 60–89, 30–59, 15–29 ml/min per 1.73m2) at baseline were 1.00, 1.28 (95% confidence interval [CI], 0.87–1.88), 1.96 (95% CI, 1.31–2.94), and 3.91 (95% CI, 2.15–7.13) (P <0.001) for all-cause mortality, and 1.00, 1.26 (95% CI, 0.78–2.04), 1.94 (95% CI, 1.17–3.20), and 3.77 (95% CI, 1.80–7.89) (P <0.001) for CVD mortality, respectively. After excluding subjects who died during the first 2 years of follow-up (n = 113), the graded associations of eGFR with the risks of all-cause and CVD morality were still present. The addition of eGFR to a model including traditional cardiovascular risk factors resulted in significant improvement in the prediction of all-cause and CVD mortality.ConclusionsReduced eGFR (< 60 ml/min per 1.73 m2) at baseline is associated with increased risks of all-cause and CVD mortality among Chinese patients with CHD.

<p>Chronic Kidney Disease And Associated Risk Factors Among Cardiovascular Patients</p>

“…In this study, the self-responsive hypertension was not significantly associated with CKD ( p = 0.075) although SBP was significantly associated with CKD defined by MDRD equation ( p = 0.023). This contradicts with the finding of Chen et al4 and Amenos et al15 The differences might be due to many patients didn`t know whether they are hypertensive or not and our patients were mainly less than 60 years old. Nowadays, some studies suggest the greater use of antihypertensive medications and specific drug classes such as diuretics, angiotensin converting enzyme inhibitors, and angiotensin II receptor blockers to control blood pressure may affect kidney function independently of their effect on blood pressure 29,40,41.…”

“…CKD is a global health burden with a high economic cost to health systems9,10 and higher among patients with CVD 11,12. The factors underlying the increased prevalence of CKD are the progressive aging, diabetes mellitus, and high blood pressure, most of which are present in patients with CVD 4,13–15. Blood pressure may be viewed as a continuous variable that fluctuates throughout the day and night in CKD and follows a circadian rhythm with a greater prevalence of daytime hypotension and non/reverse dipper status (ie, higher night-time SBP), which are risky for cardiovascular (CV) events 16,17.…”

Ten things to know about ten cardiovascular disease risk factors

“…An estimated glomerular filtration rate (eGFR) < 60 mg/min/1.73 m 2 increases the risk of death, CVD events, and hospitalizations [303] Among patients with coronary heart disease, an eGFR < 30 mg/min/1.73 m 2 substantially increases the risk of CVD mortality and all-cause mortality. [315] CVD is a leading cause of death among patients with CKD, [299] In patients without CKD (who are often younger), cancer and CVD are the two most common causes of death. Among patients with CKD, CVD is the most common cause of death, with increasing risk of CVD death inversely related to the eGFR.…”

Ten things to know about ten cardiovascular disease risk factors (“ASPC Top Ten – 2020”)

“…An estimated glomerular filtration rate (eGFR) glomerular filtration rate ​< ​60 ​mg/min/1.73 ​m 2 increases the risk of death, CVD events, and hospitalizations [ 152 ] Among patients with coronary heart disease, an eGFR ​< ​30 ​mg/min/1.73 ​m 2 substantially increases the risk of CVD mortality and all-cause mortality [ 157 ].…”