Chronic kidney disease (CKD) is commonly asymptomatic but associated with an increased risk of recurrent cardiovascular disease (CVD) events in people with coronary heart disease (CHD). The objective of this cohort study was to investigate the prevalence of CKD in individuals with established CHD, its determinants and short-term prognosis. A total of 10349 patients with CHD (men 75.6%; average (SD) age 63.8 (9.6) years) were investigated with eGFR and urinary albumin/creatinine ratio (UACR). Follow-up data (median 1.6 years; IQR 1.2-2.0) for fatal and non-fatal cardiovascular CVD events were available in 9872 (95.4%) patients with time to the first CV-death, non-fatal myocardial infarction, stroke, hospitalization for heart failure, by-pass surgery or percutaneous coronary intervention as the primary endpoint. CKD was defined according to KDIGO as mild, moderate, high or very high (UACR 0-29 mg/g or 30-299 mg/g or ≥ 300 mg/g, respectively) and/or eGFR <60 ml/min/1.73 m2). Based on a combination of eGFR and UACR 27.3% of the patients had CKD, 18.2% at low or moderate and 9.1% at high or very high risk. Without an UACR 48.9% of these patients would not have been diagnosed. The risk, higher among women than men, correlated with age, history of diabetes, high waist-to-height ratio, low physical activity and hyperglycaemia. The primary endpoint was reached in 9.9% of the low-risk CKD patients, 15.0% of the moderate-risk and 22.2% of the high-risk patients. The risk remained significantly increased in the moderate and high-risk CKD stages after adjustment for CV risk factors (moderate risk: HR 1.39; 95%CI 1.19-1.63; p<0.0001; high-risk 1.75; 1.44-2.12; p<0001). CKD is common among people with CHD and constitutes an independent risk factor for recurrent CVD events. Many CKD cases would be missed without universal UACR screening. Accordingly, it is important to actively screen for the presence of CKD in CHD patients using both eGFR and UACR as there are several kidney protective therapeutic drugs available.
Al-Azzawy et al. (Tue,) studied this question.