Impairment of Kidney Function in Patients with Chronic Coronary Syndromes

Abstract

Background: Kidney function is critical for cardiovascular health, and its appropriate assessment entails proper determination of prognosis in patients with chronic coronary syndromes (CCSs). However, assessment of the urinary spot albumin to creatinine ratio (uACR) is often overlooked, whereas it is crucial for determination of chronic kidney disease (CKD). This study assesses the prevalence of impaired kidney function in patients with CCS based on their eGFR and albuminuria. Methods and results: This study comprised a total of 1957 patients from seven regions in Poland, aged ≤ 80 years, who, 6-18 months earlier, were hospitalized for acute coronary syndrome or elective myocardial revascularization. Complete uACR and eGFR data were obtained from 1152 patients (median age was 67 years, and 71.23% of participants were male). The finding of albuminuria reclassified the CKD in 17% (200) patients, suggesting that a patient's risk cannot be ascertained only based on their eGFR result. CKD reclassification by albuminuria was observed in older (p < 0.001) patients with higher BPs (p = 0.008), BPd (p = 0.038), HR (p < 0.001), fasting glucose (p < 0.001), and HbA1c (p < 0.001) and decreased HDL concentration (p = 0.001); hence, this is the population where uACR assessment is particularly valuable. Conclusions: In a notable percentage of patients with CCS, their kidney function classification is changed based on their albuminuria. Therefore, it is important to include albuminuria in the routine assessment of patients with cardiovascular disease.

Keywords: KDIGO classification; chronic coronary syndrome; eGFR; urine albumin/creatin ratio.

Figure 1

Classification of chronic renal disease (as defined by Renal Disease: Improving Global Outcomes in 2012) based on albuminuria and estimated GFR in all patients with CCS. N = 1152 N—population with known eGFR and albuminuria. Colors: green—preserved function; yellow—mild CKD; orange—moderate CKD (high CVD risk); red—severe CKD (very high CVD risk).

Figure 2

Association of clinical variables with eGFR < 60 mL/min/1.73 m² adjusted for age, gender, and weight in multivariate logistic regression analysis. ^a Per 0.1 units; ^b Per 0.01 units; ^c Per 0.001 units. Abbreviations: see Table 1.

Figure 3

Multivariable (logistic regression analysis) predictors of mild, moderate, or severe CKD (adjusted for age, gender, and weight). ^a Per 0.1 units; ^b Per 0.01 units; ^c Per 0.001 units. Abbreviations: see Table 1.

Figure 4

The odds ratio for reclassification of the CKD group after adding albuminuria to eGFR (adjusted for age, gender, and weight) using logistic regression analysis. ^a Per 0.1 units; ^b Per 0.01 units; ^c Per 0.001 units. Abbreviations: see Table 1.