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Painless myocardial ischemia is associated with mortality in patients with chronic kidney disease

James B Wetmore1, Mike Broce, Amer Malas

  • 1Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, Kans 66160, USA. jwetmore @ kumc.edu

Nephron. Clinical Practice
|March 8, 2013
PubMed

Insights

Painless myocardial ischemia (PMI) is common in chronic kidney disease (CKD) patients and linked to lower kidney function. This condition significantly increases mortality risk in CKD individuals.

Area of Science:

  • Cardiology
  • Nephrology
  • Clinical Outcomes Research

Background:

  • Painless myocardial ischemia (PMI) is linked to adverse outcomes in the general population.
  • Chronic kidney disease (CKD) is associated with increased cardiovascular risk and mortality.
  • The relationship between PMI, kidney function, and survival in CKD patients remains unclear.

Purpose of the Study:

  • To investigate the prevalence of PMI in patients with varying levels of kidney function.
  • To determine the association between PMI, CKD, and long-term mortality.
  • To explore if PMI contributes to the high cardiovascular mortality observed in CKD.

Main Methods:

  • A cohort of 356 patients undergoing percutaneous coronary intervention were evaluated.
  • Painless myocardial ischemia (PMI) was defined as the absence of chest pain during balloon angioplasty.
  • Cox proportional hazards models were used to assess 10-year all-cause mortality risk.

Main Results:

  • PMI prevalence increased with declining estimated glomerular filtration rate (eGFR), from 20.6% (eGFR ≥ 90) to 50.0% (eGFR < 30).
  • Individuals with both CKD and PMI exhibited the highest 10-year mortality risk (HR 2.08).
  • CKD alone was associated with increased mortality (HR 1.64) compared to those without CKD or PMI.

Conclusions:

  • Painless myocardial ischemia is highly prevalent in the CKD population and inversely correlates with eGFR.
  • PMI significantly elevates mortality risk in CKD patients, potentially explaining some of the excess cardiovascular mortality.
  • These findings highlight the importance of identifying PMI in CKD patients for risk stratification and management.
Abstract

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