Pathophysiological and Experimental Pathology, Department of Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.
Am J Kidney Dis. 2010 Jan;55(1):21-30. doi: 10.1053/j.ajkd.2009.06.034. Epub 2009 Sep 18.
Chronic kidney disease (CKD) is associated with increased risk of coronary heart disease. However, information regarding the histopathologic characteristics of coronary atherosclerosis in individuals with CKD is scarce. This study investigated the relationship between CKD and severity of coronary atherosclerosis in population-based autopsy samples.
Cross-sectional study.
SETTING & PARTICIPANTS: 126 individuals randomly selected from 844 consecutive population-based autopsy samples.
Estimated glomerular filtration rate (eGFR) calculated using the 6-variable Modification of Diet in Renal Disease (MDRD) Study equation.
Severity of atherosclerosis in 3 main coronary arteries, including atherosclerotic lesion types defined using the American Heart Association classification; stenosis rates; and coronary calcified lesions.
The relationship between CKD and severity of coronary atherosclerosis was evaluated using generalized estimating equation methods.
Frequencies of advanced atherosclerotic lesions increased gradually as eGFR decreased (33.6%, 41.7%, 52.3%, and 52.8% for eGFRs > or = 60, 45-59, 30-44, and <30 mL/min/1.73 m(2), respectively; P for trend = 0.006). This relationship was substantially unchanged even after adjustment for potential confounding factors (ORs, 1.40 [95% CI, 0.76-2.55], 2.02 [95% CI, 0.99-4.15], and 3.02 [95% CI, 1.22-7.49] for eGFRs of 45-59, 30-44, and <30 mL/min/1.73 m(2), respectively). Frequencies of calcified lesions of coronary arteries also increased gradually with lower eGFRs (P for trend = 0.02). Hypertension and diabetes were associated with increased risk of advanced coronary atherosclerosis and calcification of coronary arteries in individuals with decreased eGFR.
Cross-sectional study, absence of data for proteinuria, and extremely high proportion of aged people.
The autopsy findings presented here suggest that CKD is associated significantly with severity of coronary atherosclerosis. Patients with CKD should be considered a high-risk population for advanced coronary atherosclerosis.
慢性肾脏病（CKD）与冠心病风险增加相关。然而，关于 CKD 患者冠状动脉粥样硬化的组织病理学特征的信息却很少。本研究在基于人群的尸检样本中调查了 CKD 与冠状动脉粥样硬化严重程度之间的关系。
横断面研究。
从 844 例连续的基于人群的尸检样本中随机选择了 126 人。
使用 6 变量改良肾脏病饮食研究（MDRD）方程计算的肾小球滤过率（eGFR）。
3 条主要冠状动脉粥样硬化的严重程度，包括使用美国心脏协会分类定义的动脉粥样硬化病变类型；狭窄率；以及冠状动脉钙化病变。
使用广义估计方程方法评估 CKD 与冠状动脉粥样硬化严重程度之间的关系。
随着 eGFR 的降低，高级动脉粥样硬化病变的频率逐渐增加（eGFR 分别为≥60、45-59、30-44 和<30 mL/min/1.73 m²时为 33.6%、41.7%、52.3%和 52.8%；P 趋势=0.006）。即使在调整了潜在混杂因素后，这种关系仍然基本保持不变（eGFR 为 45-59、30-44 和<30 mL/min/1.73 m²时的比值比分别为 1.40[95%可信区间，0.76-2.55]、2.02[95%可信区间，0.99-4.15]和 3.02[95%可信区间，1.22-7.49]）。冠状动脉钙化病变的频率也随着 eGFR 的降低而逐渐增加（P 趋势=0.02）。高血压和糖尿病与 eGFR 降低的个体中高级冠状动脉粥样硬化和冠状动脉钙化的风险增加相关。
横断面研究，缺乏蛋白尿数据，以及老年人的比例极高。
这里呈现的尸检结果表明，CKD 与冠状动脉粥样硬化的严重程度显著相关。CKD 患者应被视为高级冠状动脉粥样硬化的高危人群。
