Engelbertz Christiane, Reinecke Holger, Breithardt Günter, Schmieder Roland E, Fobker Manfred, Fischer Dieter, Schmitz Boris, Pinnschmidt Hans O, Wegscheider Karl, Pavenstädt Hermann, Brand Eva
Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.
Department of Nephrology and Hypertension, University of Erlangen-Nuernberg, Erlangen, Germany.
Int J Cardiol. 2017 Sep 15;243:65-72. doi: 10.1016/j.ijcard.2017.05.022. Epub 2017 May 7.
Chronic kidney disease (CKD) and coronary artery disease (CAD) are strongly associated. CAD is the most frequent cause of cardiovascular death in patients with CKD.
The prospective observational nationwide multicenter Coronary Artery Disease and REnal Failure (CAD-REF) Registry enrolled 3352 patients with angiographically documented CAD classified according to their baseline estimated glomerular filtration rate (eGFR) into 5 groups according to the K/DOQI-guidelines. Patients were followed for two years. The aim of this study was the analysis of outcome and the identification of risk factors for two-year mortality in patients with both CKD and CAD.
With decreasing renal function, patients had more often diabetes mellitus, hypertension, peripheral artery disease, and previous cardiovascular events and interventions. The amount of diseased vessels increased with decreasing renal function. For the whole cohort, two-year mortality was 6.5%. Kaplan-Meier-curves showed highest mortality in patients with CKD stages 4 and 5 (22.4%). In multivariate Cox-regression analyses, significant risk factors for two-year all-cause mortality were lower eGFR, current smoking, left ventricular ejection fraction, diabetes mellitus treated with oral medication or insulin, age, and peripheral artery disease. Coronary status missed the level of statistical significance as a risk factor for mortality in multivariable regression analysis. An eGFR reduction of 10ml/min/1.73m increased the risk of mortality by 19% regardless of other risk factors.
Two-year morbidity and mortality increased with the degree of renal impairment. To improve survival of patients with CAD and CKD, nephroprotection is urgently needed especially for patients with atherosclerotic burden.
NCT00679419, http://clinicaltrials.gov/.
慢性肾脏病（CKD）与冠状动脉疾病（CAD）密切相关。CAD是CKD患者心血管死亡的最常见原因。
前瞻性观察性全国多中心冠状动脉疾病与肾衰竭（CAD-REF）登记研究纳入了3352例经血管造影证实患有CAD的患者，根据其基线估计肾小球滤过率（eGFR）按照K/DOQI指南分为5组。对患者进行了两年的随访。本研究的目的是分析CKD和CAD患者的两年结局并确定两年死亡率的危险因素。
随着肾功能下降，患者更常患有糖尿病、高血压、外周动脉疾病以及既往心血管事件和干预史。病变血管数量随肾功能下降而增加。对于整个队列，两年死亡率为6.5%。Kaplan-Meier曲线显示CKD 4期和5期患者死亡率最高（22.4%）。在多变量Cox回归分析中，两年全因死亡率的显著危险因素为较低的eGFR、当前吸烟、左心室射血分数、口服药物或胰岛素治疗的糖尿病、年龄和外周动脉疾病。冠状动脉状态在多变量回归分析中作为死亡率危险因素未达到统计学显著水平。eGFR每降低10ml/min/1.73m²，无论其他危险因素如何，死亡风险增加19%。
两年发病率和死亡率随肾功能损害程度增加。为提高CAD和CKD患者的生存率，迫切需要进行肾脏保护，尤其是对于有动脉粥样硬化负担的患者。
NCT00679419，http://clinicaltrials.gov/
