Cardiovascular Center, Seoul National University Hospital, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
Atherosclerosis. 2010 Feb;208(2):406-11. doi: 10.1016/j.atherosclerosis.2009.08.040. Epub 2009 Aug 31.
The purpose of this study is to assess the independent association between early CKD (stages 1-3a) with coronary atherosclerosis and the feasibility of risk stratification of coronary atherosclerosis according to The Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines using non-invasive coronary angiography.
We consecutively enrolled 4297 asymptomatic subjects who underwent coronary CT angiography as part of a general health evaluation and had estimated glomerular filtration rates (eGFR) over 45 ml/min/1.73 m(2). Subjects were categorized from no CKD to stage 3a CKD, and multiple regression analyses for coronary atherosclerosis were performed.
Early CKD was an independent risk factor for coronary artery disease (CAD) and obstructive CAD. However, neither the risk of CAD nor CACS >100 increased as stage of CKD advanced. The reason for unsuccessful stratification of coronary atherosclerosis risk was that the presence of proteinuria, which was used to define stages 1 and 2 CKD, was an independent risk factor for coronary atherosclerosis, but eGFR of 45-89 ml/min/1.73 m(2) was not associated with coronary atherosclerosis.
Early CKD was an independent risk factor for coronary atherosclerosis, and the risk stratification for coronary atherosclerosis should be based on the presence of proteinuria rather than decreased eGFR within early CKD.
本研究旨在评估早期慢性肾脏病（1-3a 期）与冠状动脉粥样硬化的独立相关性，并通过冠状动脉 CT 血管造影术评估根据肾脏病预后质量倡议（K/DOQI）指南对冠状动脉粥样硬化进行风险分层的可行性。
我们连续纳入了 4297 名无症状患者，他们作为一般健康评估的一部分接受了冠状动脉 CT 血管造影检查，肾小球滤过率（eGFR）超过 45 ml/min/1.73 m(2)。根据有无慢性肾脏病以及慢性肾脏病分期对患者进行分组，并对冠状动脉粥样硬化进行多元回归分析。
早期慢性肾脏病是冠状动脉疾病（CAD）和阻塞性 CAD 的独立危险因素。然而，随着慢性肾脏病分期的进展，CAD 的风险或 CACS>100 并未增加。未能对冠状动脉粥样硬化风险进行分层的原因是，蛋白尿的存在被用来定义 1 期和 2 期慢性肾脏病，它是冠状动脉粥样硬化的独立危险因素，而 45-89 ml/min/1.73 m(2)的 eGFR 与冠状动脉粥样硬化无关。
早期慢性肾脏病是冠状动脉粥样硬化的独立危险因素，而冠状动脉粥样硬化的风险分层应基于蛋白尿的存在，而不是早期慢性肾脏病中 eGFR 的降低。
