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Updated: Sep 30, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Patient-Reported Symptoms and Subsequent Risk of Myocardial Infarction in Chronic Kidney Disease
Benjamin Lidgard1, Leila R Zelnick, Kevin D O'Brien
1Department of Medicine, University of Washington, Seattle, Washington.
Insights
In patients with chronic kidney disease (CKD), typical atherosclerotic symptoms like chest pain and shortness of breath significantly increase the risk of myocardial infarction. Early recognition of these symptoms is crucial for timely intervention in CKD patients.
Area of Science:
- Nephrology
- Cardiology
- Epidemiology
Background:
- Patients with chronic kidney disease (CKD) often present with atypical symptoms during acute cardiovascular events.
- The association between typical atherosclerotic symptoms and subsequent myocardial infarction risk in ambulatory CKD patients remains understudied.
Purpose of the Study:
- To investigate the relationship between common atherosclerotic symptoms and the risk of developing myocardial infarction in individuals with CKD.
- To determine if symptoms like chest pain, shortness of breath, and stair-climbing limitations predict future heart attacks in this population.
Main Methods:
- Analysis of data from the Chronic Renal Insufficiency Cohort Study, including 3910 participants.
- Annual assessment of symptoms (chest pain, shortness of breath, stair-climbing ability) using the Kidney Disease Quality of Life Instrument.
- Cox regression models were employed to evaluate the association between time-updated symptoms and incident myocardial infarction.
Main Results:
- Over a median follow-up of 10.4 years, 476 incident myocardial infarctions occurred.
- Chest pain, shortness of breath, and limitations in stair climbing were significantly associated with an increased risk of myocardial infarction.
- The risk for myocardial infarction increased with the severity of reported symptoms.
Conclusions:
- In ambulatory adults with CKD, the presence and severity of atherosclerotic cardiovascular disease symptoms are strongly linked to a higher risk of subsequent myocardial infarction.
- These findings highlight the importance of symptom assessment in managing cardiovascular risk in CKD patients.
Background And Objectives:
Although patient-reported symptoms often precede acute presentations of cardiovascular disease, patients with nondialysis-requiring CKD are less likely to have typical symptoms of atherosclerotic disease when presenting with acute myocardial infarction. However, the associations between typical atherosclerotic symptoms and subsequent risk of myocardial infarction are unknown in ambulatory patients with CKD.
Design, Setting, Participants, & Measurements:
To determine whether typical atherosclerotic symptoms are associated with risk for subsequent myocardial infarction in people with CKD, we examined participants from the Chronic Renal Insufficiency Cohort Study. Chest pain, shortness of breath, and inability to climb stairs were evaluated annually using the Kidney Disease Quality of Life Instrument. Associations between categorical time-updated symptoms and physician-adjudicated incident myocardial infarction were assessed using Cox regression models.
Results:
Among 3910 participants (mean age of 58±11 years; mean eGFR =44±15 ml/min per 1.73 m2), there were 476 incident myocardial infarctions over a median follow-up period of 10.4 years (interquartile range, 5.36-12.6 years). Median time from symptom assessment to incident myocardial infarction was 213 days (interquartile range, 111-333 days). Compared with no symptoms, mild, and moderate or worse, symptoms of chest pain (hazard ratio, 1.30; 95% confidence interval, 1.01 to 1.67; and hazard ratio, 1.70; 95% confidence interval, 1.27 to 2.27, respectively) and shortness of breath (hazard ratio, 1.37; 95% confidence interval, 1.10 to 1.70; and hazard ratio, 1.33; 95% confidence interval, 1.05 to 1.69, respectively) were significantly associated with greater risks for subsequent myocardial infarction. Participants reporting mild and severe limitations in climbing stairs (versus no limitation) had significantly higher adjusted risk of myocardial infarction (hazard ratio, 1.44; 95% confidence interval, 1.10 to 1.89; and hazard ratio, 1.89; 95% confidence interval, 1.44 to 2.49, respectively).
Conclusions:
In a large ambulatory cohort of adults with CKD, symptoms of atherosclerotic cardiovascular disease were strongly associated with a higher risk for subsequent myocardial infarction.
Podcast:
This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2022_03_17_CJN12080921.mp3.
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