BARCELONA — Mild renal impairment can have a substantial effect on the rate of death or myocardial infarction in patients with coronary artery disease, according to a review of more than 5,000 patients.
“Renal insufficiency is usually defined as a glomerular filtration rate [GFR] of less than 60 mL/min 1.73 per m
“Many physicians only care about renal function if a patient's serum creatinine is more than 2 mg/dL. For non-nephrologists it's a new concept that mild renal dysfunction” can have a significant effect on outcomes, said Dr. Don Poldermans, a professor in the department of anesthesiology at Erasmus University Medical Center in Rotterdam, the Netherlands, and a coauthor of the poster.
The study reviewed 5,041 patients who were seen at Erasmus Medical Center with known or suspected coronary artery disease during 1993–2004. None of these patients was on dialysis. Their follow-up ranged from 6 months to 12 years with an average of 6 years.
Renal function was normal (GFR greater than 80) in 41%, mildly impaired in 28%, moderately impaired (GFR 41–60) in 19%, and severely impaired (GFR 40) in 12%.
The researchers then determined the rate of all-cause death, cardiac death, and nonfatal MI in each subgroup, and calculated the risk for each end point faced by each group relative to patients with normal renal function and adjusted for baseline demographic and clinical differences.
The results showed a substantial and statistically significant increased risk for all three adverse outcomes that tracked with the extent of renal impairment (see chart), reported Dr. van Domburg, a researcher in the Thoraxcenter at Erasmus University Medical Center.
The implication is that all patients with known or suspected coronary artery disease and any degree of impaired renal function should undergo close surveillance and intensive medical therapy, including treatment with a statin, an ACE inhibitor, and a β-blocker, the authors concluded.
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