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Updated: Jun 10, 2026
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Renal function and risk stratification of diabetic and nondiabetic patients undergoing evaluation for coronary artery
Abdul Hakeem1, Sabha Bhatti, Kunal N Karmali
1Division of Cardiovascular Diseases, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA. ahakeem@gmail.com
Insights
Estimated glomerular filtration rate (eGFR) and myocardial perfusion imaging (MPI) improve risk stratification for diabetic and nondiabetic patients. Diabetic patients without chronic kidney disease (CKD) have similar cardiac outcomes to nondiabetic patients, while CKD identifies high-risk diabetic patients.
Area of Science:
- Cardiology
- Nephrology
- Nuclear Medicine
Background:
- Coronary artery disease (CAD) is a leading cause of death in diabetic individuals, who exhibit heterogeneous cardiovascular risk.
- Effective risk stratification is crucial for managing diabetic patients with suspected ischemia.
Purpose of the Study:
- To assess the impact of renal function, measured by estimated glomerular filtration rate (eGFR), on risk stratification in patients undergoing myocardial perfusion imaging (MPI).
- To evaluate the combined utility of MPI and eGFR in predicting cardiac death (CD) in diabetic and nondiabetic individuals.
Main Methods:
- A cohort of 1,747 patients (37% diabetic) undergoing MPI for suspected ischemia were followed for cardiac death.
- Chronic kidney disease (CKD) was defined as an eGFR <60 ml/min.
- Statistical analyses, including Cox proportional hazards models, were used to assess risk factors for CD.
Main Results:
- In patients with normal MPI scans, the annual CD rate was significantly higher in those with CKD (alone or with diabetes) compared to those without CKD.
- Patients with both diabetes and CKD had a 2.7-fold increased risk of CD compared to those without diabetes and CKD, even after adjusting for other risk factors.
- The presence and severity of perfusion defects increased CD risk, with CKD conferring a substantially higher risk across all defect strata.
Conclusions:
- Myocardial perfusion imaging (MPI) combined with eGFR offers valuable risk stratification for both diabetic and nondiabetic patients.
- Diabetic patients without CKD demonstrate comparable short-term cardiac outcomes to nondiabetic patients.
- The presence of underlying CKD identifies a high-risk subgroup among diabetic patients, necessitating closer monitoring and management.
Objectives:
The aim of this study was to evaluate the impact of renal function by estimated glomerular filtration rate (eGFR) on risk stratification of diabetic and nondiabetic patients undergoing myocardial perfusion imaging (MPI) by single-photon emission computed tomography for suspected ischemia.
Background:
Coronary artery disease is the leading cause of death among diabetic persons; however, diabetic persons are a very heterogeneous group in terms of cardiovascular risk, necessitating further risk stratification.
Methods:
Patients (n = 1,747, age 65 +/- 10 years, 37% diabetic) undergoing MPI were followed for cardiac death (CD) for a mean of 2.15 +/- 0.8 years. Chronic kidney disease (CKD) was defined by an eGFR <60 ml/min.
Results:
In the presence of a normal scan, annual CD rate was 0.9% for those with no diabetes mellitus (DM) and no CKD, 0.5% in the DM alone group, 2.35% in CKD alone, and 2.9% in those with both DM and CKD (p < 0.001). Patients with DM+CKD had a 2.7-fold risk of CD compared with no DM no CKD (p = 0.001) after controlling for age, ejection fraction, history of coronary artery disease, and other risk factors. The risk of CD increased as a function of the presence and severity of perfusion defects, regardless of CKD or DM status. Presence of CKD conferred a several-fold higher risk of CD for the various strata of perfusion defects. Log-rank test for difference in probability of CD was nonsignificant for comparison between patients with no DM no CKD and those with DM alone (p = 0.73) but was significant for comparison between patients with no DM no CKD and patients with CKD alone (p < 0.001) or DM+CKD (p < 0.001).
Conclusions:
MPI and eGFR provide valuable risk stratification for diabetic and nondiabetic patients. Diabetic patients without CKD seem to have similar short-term cardiac outcomes compared with nondiabetic patients. Underlying CKD seems to identify a high-risk subgroup of diabetic patients.
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