Mild renal dysfunction and long-term adverse outcomes in women with chest pain: results from the National Heart, Lung, and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation (WISE)

Abstract

Background: Chronic kidney disease (CKD) is associated with accelerated atherosclerosis and adverse cardiovascular outcomes, but mechanisms are unclear. We hypothesized that mild CKD independently predicts adverse outcomes in women with symptoms and signs of ischemia.

Methods: We categorized 876 women from the Women's Ischemia Syndrome Evaluation cohort according to estimated glomerular filtration rate (eGFR) (eGFR ≥90 mL/min per 1.73 m(2) [normal], 60-89 mL/min per 1.73 m(2) [mild CKD], ≤59 mL/min per 1.73 m(2) [severe CKD]). Time to death from all-cause and cardiovascular causes and major adverse outcomes were assessed by multivariate regression adjusted for baseline covariates.

Results: Obstructive coronary artery disease (CAD) was present only in few patients (39%). Even after adjusting for CAD severity, renal function remained a strong independent predictor of all-cause and cardiac mortality (P < .001). Every 10-unit decrease in eGFR was associated with a 14% increased risk of all-cause mortality (adjusted hazard ratio [AHR] 1.14 [1.08-1.20], P < .0001), 16% increased risk of cardiovascular mortality (AHR 1.16 [1.09-1.23], P < .0001), and 9% increased risk of adverse cardiovascular events (AHR 1.09 [1.03-1.15], P = .002).

Conclusions: Even mild CKD is a strong independent predictor of all-cause and cardiac mortality in women with symptoms/signs of ischemia, regardless of underlying obstructive CAD severity, underscoring the need to better understand the interactions between ischemic heart disease and CKD.

Trial registration: ClinicalTrials.gov NCT00000554.

Copyright © 2015 Elsevier Inc. All rights reserved.

Figures

Figure 1. Kaplan-Meier Survival Analysis: Freedom from all-cause mortality

All-cause mortality in women with mild and severe renal failure increased compared with those with normal renal function. eGFR=estimated glomerular filtration rate

Figure 2. Kaplan-Meier Survival Analysis: Freedom from cardiovascular mortality

Cardiovascular mortality in women with mild and severe renal failure increased compared with those with normal renal function. eGFR=estimated glomerular filtration rate

Figure 3. Mortality, eGFR and Severity of CAD

(A) All-cause mortality stratified by eGFR and CAD Severity Score (B) Cardiovascular mortality stratified by eGFR and CAD Severity Score. eGFR=estimated glomerular filtration rate in ml/min/1.73 m2

Figure 3. Mortality, eGFR and Severity of CAD

(A) All-cause mortality stratified by eGFR and CAD Severity Score (B) Cardiovascular mortality stratified by eGFR and CAD Severity Score. eGFR=estimated glomerular filtration rate in ml/min/1.73 m2