Moayad Al-Azzawy Safi, Coyle Mark, De Backer Guy, McEvoy John William, Jennings Catriona, Kotseva Kornelia, Mellbin Linda, Rydén Lars, Wood David, De Bacquer Dirk, Groop Per-Henrik
Department of Medicine Solna, Karolinska Institutet, FoU - Tema Hjärta och Kärl, 171 76 Stockholm, Sweden.
University of Galway School of Medicine and National Institute for Prevention and Cardiovascular Health, Moyola Lane, Newcastle, Galway H91 FF68, Ireland and Imperial College Healthcare NHS Trust, London, UK.
Eur J Prev Cardiol. 2025 Aug 29. doi: 10.1093/eurjpc/zwaf528.
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.
慢性肾脏病（CKD）通常无症状，但在冠心病（CHD）患者中，其与心血管疾病（CVD）复发事件风险增加相关。本队列研究的目的是调查确诊冠心病患者中CKD的患病率、其决定因素及短期预后。
共10349例冠心病患者（男性占75.6%；平均（标准差）年龄63.8（9.6）岁）接受了估算肾小球滤过率（eGFR）和尿白蛋白/肌酐比值（UACR）检测。9872例（95.4%）患者有随访数据（中位数1.6年；四分位间距1.2 - 2.0），以首次心血管死亡、非致死性心肌梗死、中风、因心力衰竭住院、搭桥手术或经皮冠状动脉介入治疗作为主要终点。CKD根据改善全球肾脏病预后组织（KDIGO）标准定义为轻度、中度、重度或极重度（UACR分别为0 - 29mg/g或30 - 299mg/g或≥300mg/g）和/或eGFR <60ml/min/1.73m²）。
根据eGFR和UACR联合评估，27.3%的患者患有CKD，其中18.2%为低风险或中度风险，9.1%为高风险或极高度风险。若不检测UACR，48.9%的此类患者将无法被诊断。该风险在女性中高于男性，与年龄、糖尿病史、高腰高比、低体力活动及高血糖相关。低风险CKD患者中9.9%达到主要终点，中度风险患者中为15.0%，高风险患者中为22.2%。在调整心血管危险因素后，中度和高风险CKD阶段的风险仍显著增加（中度风险：风险比1.39；95%置信区间1.19 - 1.63；p<0.0001；高风险1.75；1.44 - 2.12；p<0.0001）。
CKD在冠心病患者中常见，是心血管疾病复发事件的独立危险因素。若不进行普遍的UACR筛查，许多CKD病例将会漏诊。因此，对于冠心病患者，使用eGFR和UACR积极筛查CKD很重要，因为有多种肾脏保护治疗药物可用。
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