Mild renal dysfunction and long-term adverse outcomes in women with chest pain: Results from the National Heart, Lung, and Blood Institute–sponsored Women’s Ischemia Syndrome Evaluation (WISE)

• Published in: The American heart journal Vol. 169; no. 3; pp. 412 - 418
• Main Authors: Mohandas, Rajesh, MD, MPH, Segal, Mark, MD, PhD, Srinivas, Titte R., MD, Johnson, B. Delia, PhD, Wen, Xuerong, PhD, Handberg, Eileen M., PhD, Petersen, John W., MD, MS, Sopko, George, MD, Merz, C. Noel Bairey, MD, Pepine, Carl J., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2015; Elsevier Limited
• Subjects: Age; Aged; Blood; Cardiovascular; Cardiovascular disease; Chest Pain - mortality; Chest Pain - physiopathology; Coronary Artery Disease - mortality; Coronary Artery Disease - physiopathology; Coronary vessels; Diabetes; Female; Glomerular Filtration Rate; Heart; Heart attacks; Heart rate; Humans; Hypertension; Ischemia; Kaplan-Meier Estimate; Kidney - physiopathology; Kidney diseases; Laboratories; Medical imaging; Middle Aged; Mortality; Myocardial Ischemia - mortality; Myocardial Ischemia - physiopathology; Renal Insufficiency - physiopathology; Risk Assessment; Severity of Illness Index; Studies; Women's Health; eGFR; CAD; Chronic kidney disease; HR; HRT; DASI; WISE; Coronary artery disease; Duke Activity Status Index; Estimated glomerular filtration rate; Hazard ratio; Body mass index; Women’s Ischemia Syndrome Evaluation; Hormone replacement therapy; CKD; BMI
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2014.12.010

Background Chronic kidney disease (CKD) is associated with accelerated atherosclerosis and adverse cardiovascular outcomes, but mechanisms are unclear. We hypothesized that mild CKD independently predicts adverse outcomes in women with symptoms and signs of ischemia. Methods We categorized 876 women from the Women’s Ischemia Syndrome Evaluation cohort according to estimated glomerular filtration rate (eGFR) (eGFR ≥90 mL/min per 1.73 m2 [normal], 60-89 mL/min per 1.73 m2 [mild CKD], ≤59 mL/min per 1.73 m2 [severe CKD]). Time to death from all-cause and cardiovascular causes and major adverse outcomes were assessed by multivariate regression adjusted for baseline covariates. Results Obstructive coronary artery disease (CAD) was present only in few patients (39%). Even after adjusting for CAD severity, renal function remained a strong independent predictor of all-cause and cardiac mortality ( P < .001). Every 10-unit decrease in eGFR was associated with a 14% increased risk of all-cause mortality (adjusted hazard ratio [AHR] 1.14 [1.08-1.20], P < .0001), 16% increased risk of cardiovascular mortality (AHR 1.16 [1.09-1.23], P < .0001), and 9% increased risk of adverse cardiovascular events (AHR 1.09 [1.03-1.15], P = .002). Conclusions Even mild CKD is a strong independent predictor of all-cause and cardiac mortality in women with symptoms/signs of ischemia, regardless of underlying obstructive CAD severity, underscoring the need to better understand the interactions between ischemic heart disease and CKD.