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Published on: June 28, 2019
Mild renal insufficiency is associated with reduced coronary flow in patients with non-obstructive coronary artery
A R Chade1, D Brosh, S T Higano
1Division of Nephrology and Hypertension, Mayo Clinic College of Medicine, Rochester, Minnesota 55902, USA.
Insights
Early chronic kidney disease (CKD) is linked to reduced coronary vasodilator capacity, even in patients without obstructive coronary artery disease. This suggests parallel microcirculation issues in kidneys and heart, increasing cardiovascular risk.
Area of Science:
- Cardiology
- Nephrology
- Microcirculation Research
Background:
- Patients with chronic kidney disease (CKD) face higher cardiovascular event risks.
- The link between CKD and coronary microvascular disease is not fully understood.
- Early detection of microvascular dysfunction is crucial for cardiovascular risk stratification.
Purpose of the Study:
- To investigate the association between early chronic kidney disease (CKD) and coronary microvascular disease.
- To evaluate coronary vasodilator capacity in patients with normal or mildly diseased coronary arteries and varying levels of kidney function.
- To determine if reduced glomerular filtration rate (GFR) correlates with impaired coronary flow reserve (CFR).
Main Methods:
- Study included 605 patients with normal or mildly diseased coronary arteries undergoing angiography.
- Coronary flow reserve (CFR) was assessed using intracoronary adenosine.
- Patients were categorized based on estimated glomerular filtration rate (eGFR), with CKD defined as eGFR < 60 ml/min/1.73 m(2).
Main Results:
- Patients with CKD (eGFR < 60 ml/min/1.73 m(2)) exhibited significantly lower CFR compared to those with normal GFR (eGFR ≥ 60 ml/min/1.73 m(2)).
- The CKD group showed reduced CFR (2.6±0.6) versus the normal GFR group (3.0±0.8), with P<0.001.
- Logistic regression confirmed reduced renal function as independently associated with attenuated coronary vasodilator capacity after adjusting for age, gender, and hypertension.
Conclusions:
- Reduced renal function, indicative of early CKD, is associated with impaired coronary vasodilator capacity in patients without obstructive coronary artery disease.
- The correlation between low GFR and reduced CFR suggests parallel alterations in renal and coronary microcirculation.
- This microvascular impairment may signify an unmeasured risk factor, contributing to the heightened cardiovascular risk observed in CKD patients.
Abstract:
Patients with chronic kidney disease (CKD) have increased risk for cardiovascular events. However, the association between these pathophysiological processes is unclear. Therefore, this study was designed to determine the association between early CKD and coronary microvascular disease in patients with normal or mildly diseased coronary arteries. A total of 605 patients with normal or mildly diseased coronary arteries based on angiography underwent coronary flow reserve (CFR) evaluation using intracoronary adenosine. Patients were divided based on glomerular filtration rate (GFR). CKD was defined as calculated GFR<60 ml/min/1.73 m(2). Patients with normal GFR (> or =60 ml/min/1.73 m(2), n=481) had higher CFR compared to those with CKD (n=124, CFR=3.0+/-0.8 vs 2.6+/-0.6, P<0.001, respectively). Patients with abnormal GFR were more likely to be older and of female gender, with greater prevalence of hypertension. Multiple logistic regression analysis adjusted for the aforementioned risk factors further supported the observed relationship. The current study shows that reduced renal function is associated with attenuated coronary vasodilator capacity in patients without obstructive coronary artery disease. The correlation between low GFR and reduced CFR may suggest parallel alterations in the renal and coronary microcirculation at the early stage of disease. Impairment in both microcirculatory beds may reflect an unmeasured risk factor induced by blunted renal function and add a burden to the increased propensity for cardiovascular events in CKD.
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