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Updated: Jun 5, 2026
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Cardiovascular risk modification in participants with coronary disease screened by the Kidney Early Evaluation
P A McCullough1, A Whaley-Connell, W W Brown
1Department of Medicine, Division of Cardiology, William Beaumont Hospital, Royal Oak, Michigan 48073, USA. peteramccullough@gmail.com
Insights
Individuals with chronic kidney disease (CKD) exhibit poor control of coronary artery disease (CAD) risk factors. Factors like older age, male gender, and higher albumin-to-creatinine ratio are linked to worse outcomes, highlighting the need for better management strategies.
Area of Science:
- Nephrology
- Cardiology
- Public Health
Background:
- Chronic kidney disease (CKD) represents a significant cardiovascular risk state.
- Individuals with CKD require intensive management of coronary artery disease (CAD) risk factors.
- CKD is defined by an estimated glomerular filtration rate <60 mL/min/1.73 m2 or a urine albumin:creatinine ratio (ACR) ≥30 mg/g.
Purpose of the Study:
- To assess the prevalence and predictors of suboptimal coronary artery disease (CAD) risk factor management in individuals with chronic kidney disease (CKD).
- To identify factors associated with poor control of hypertension, diabetes, hyperlipidemia, and smoking in a large cohort.
- To evaluate the impact of healthcare provider specialty on CAD risk factor control in CKD patients.
Main Methods:
- A cross-sectional study of 70,454 screened volunteers.
- CKD defined by eGFR <60 mL/min/1.73 m2 or ACR ≥30 mg/g.
- Multivariate logistic regression analyzed factors associated with suboptimal CAD risk management (systolic blood pressure ≥130 mmHg, glucose ≥125 mg/dL, total cholesterol ≥200 mg/dL, or current smoking).
Main Results:
- 7.7% had a history of CAD, 1.8% prior PCI, and 1.6% prior CABG.
- Suboptimal CAD risk factor management was observed in 72.5% of the analyzed subgroup (n=38,746/53,403).
- Older age, male gender, higher ACR, increased BMI, CAD without revascularization, and care by a nephrologist were associated with worse risk factor control. Prior revascularization and cardiologist care did not show significant association.
Conclusions:
- Chronic kidney disease is strongly associated with widespread suboptimal control of coronary artery disease risk factors.
- Nephrologist care is linked to poorer risk factor management, suggesting a need for improved collaborative care models.
- Targeted interventions are crucial for improving cardiovascular risk factor control in the CKD population.
Background:
Coronary artery disease (CAD) identifies the need for intensive treatment of risk factors among individuals with chronic kidney disease (CKD), a high-risk, complex cardiovascular risk state.
Methods:
An estimated glomerular filtration rate<60 mL/min/1.73 m2 or a urine albumin:creatinine ratio (ACR)≥30 mg/g (3.4 mg/mmol) defined CKD.
Results:
Of 70,454 volunteers screened the mean age was 53.5±15.7 years and 68.3% were female. A total of 5410 (7.7%) had a self-reported history of CAD; 1295 (1.8%) had a history of prior percutaneous coronary intervention (PCI); and 1124 (1.6%) had a prior history of coronary artery bypass surgery (CABG). Multivariate analysis for the outcome of suboptimal CAD risk management (composite of systolic blood pressure≥130 mmHg, glucose≥125 mg/dL (6.9 mmol/L) for diabetics, total cholesterol≥200 mg/dL (5.2 mmol/L), or current smoking; n=38,746/53,403, 72.5%) revealed older age (per year) (odds ratio (OR)=1.04, 95% confidence interval (CI) 1.03-1.04, P<0.0001), male gender (OR=1.40, 95% CI 1.34-1.47, P<0.0001), ACR≥30 mg/g (3.4 mg/mmol) (OR=1.66, 95% CI 1.55-1.79, P<0.0001), body mass index (per kg/m2) (OR=1.06, 95% CI 1.06-1.06, P<0.0001), CAD without a history of revascularization (OR=1.14, 95% CI 1.02-1.28, P=0.02) and care received by a nephrologist (OR=1.49, 95% CI 1.22-1.83, P<0.0001) were associated with worse risk factor control. Prior coronary revascularization and being under the care of a cardiologist were not associated with either improved or suboptimal risk factor control.
Conclusions:
Chronic kidney disease is associated with overall poor rates of CAD risk factor control.
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