Prognostic significance of glomerular filtration rate estimated by the Japanese equation among patients who underwent complete coronary revascularization

Abstract

An equation that accurately estimates the glomerular filtration rate (GFR) in the Japanese population has been proposed; however, the prognostic significance of estimated GFR (eGFR) defined according to this equation has not been reported. In addition, the prognostic significance of eGFR during long-term follow-up after complete coronary revascularization remains unclear. We assessed the prognostic significance of eGFR values, estimated by the new Japanese equation, in a cohort of patients following complete coronary revascularization. We studied consecutive patients with complete revascularization from 1984 to 1992. Patients on dialysis were excluded. A novel Japanese equation was used to estimate the GFR: eGFR¼ 194Â(serum creatinine) À1.094 Â(age) À0.287 (Â0.739 if female). Multivariate Cox proportional hazards regression analyses were performed to determine all-cause and cardiac mortality. We analyzed data of 1809 patients, of whom 571 (31.6%) had an eGFR of X90 ml min À1 per 1.73 m 2 , 917 (50.7%) had an eGFR of 60-89 ml min À1 per 1.73 m 2 , 298 (16.5%) had an eGFR of 30-59 ml min À1 per 1.73 m 2 and 23 (1.3%) had an eGFR of o30 ml min À1 per 1.73 m 2 . During follow-up (11.4 ± 2.9 years), there were 397 (22.0%) all-cause and 123 (6.8%) cardiac deaths overall. Patients with an eGFR of 30-59 ml min À1 per 1.73 m 2 , and o30 ml min À1 per 1.73 m 2 revealed significantly greater risk of all-cause mortality than those with eGFR of X90 ml min À1 per 1.73 m 2 (hazard ratio (HR) 1.91, Po0.001, HR 3.35, Po0.001, respectively). Furthermore, incidence of cardiac death was higher in patients with an eGFR of 30-59 ml min À1 per 1.73 m 2 than those with an eGFR of X90 ml min À1 per 1.73 m 2 (HR 2.89, Po0.001). GFR as estimated using the new Japanese equation had a prognostic significance among patients with complete coronary revascularization.

Japan Atherosclerosis Society (JAS) Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2017

“…The results of these studies have found that, compared to patients with normal renal function, the risk for cardiovascular events, including cerebrovascular disease, cardiac death, and total mortality increases by 2–3-fold in those with CKD even when the CKD is mild. It has been reported that the risk increases in association with the severity of the disease 740 , 769 , 770 ) . In addition, according to the observational CREDO-Kyoto study, the risk for cardiovascular death is 2.9-fold higher for post-PCI patients with CKD, and the risk for total mortality increases by 2.1-fold 183 ) .…”

Efficacy and safety of avacopan in patients with ANCA-associated vasculitis receiving rituximab in a randomised trial

“…eGFR for patients with a baseline eGFR less than 30 mL/min/1.73 m² was also analysed. eGFR (in mL/min/1.73 m²) was calculated using the serum creatinine-based formula (Modification of Diet in Renal Disease) for adults, 11 the Japanese equation for Japanese adults, 12 and the modified Schwartz equation for adolescents. 13 …”

Association between Non-Lipid Residual Risk Factors and Cardiovascular Events in Patients with Stable Coronary Artery Disease Treated with Pitavastatin: An Observation from the REAL-CAD Study

“…Khaw reported that increasing HbA1c levels are associated with allcause and CV mortality in non-diabetic patients 32) . In that an increase in HbA1c of 1 percentage point was associated with a relative risk of all-cause mortality of than in those without CKD (eGFR ≥ 90 ml/min/1.73 m 2 ), suggesting that the risk of a CV event increases with worsening eGFR values [21][22][23] . Renal dysfunction could be one of the key factors associated with CV events despite aggressive lipid lowering therapy with statins 9) .…”