NDT Advance Access originally published online on November 4, 2007
Nephrology Dialysis Transplantation 2008 23(3):934-940; doi:10.1093/ndt/gfm689
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Mortality, kidney disease and cardiac procedures following acute coronary syndrome
1 Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA 2 Quintiles INC, Durham, NC, USA 3 Department of Clinical Neurosciences, Brown University School of Medicine, Providence, RI, USA 4 Scripps Translational Science Institute, La Jolla, CA, USA
Jula K. Inrig, Duke University Medical Center, Box 3646, Durham, NC 27710, USA. Tel: +1-919-6687516; Fax: +1-919-668-7128; E-mail: inrig001{at}mc.duke.edu
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Abstract |
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Background. Cardiac interventions are underutilized in patients with chronic kidney disease (CKD) following acute coronary syndrome (ACS) partly due to nephrotoxicity concerns.
Methods. We analyzed outcomes of 4631 subjects with ACS enrolled in the Blockade of the Glycoprotein IIb/IIIa Receptor to Avoid Vascular Occlusion trial, including time to death, time to reduced renal function (50% reduction in estimated glomerular filtration rate (eGFR) or development of end-stage renal disease (ESRD)) and percent change in eGFR from baseline.
Results. Subjects with a lower baseline eGFR were more likely to be older, female and have diabetes, hypertension, congestive heart failure or peripheral vascular disease (all P < 0.0001); they were less likely to be taking aspirin 
162 mg or to have undergone a percutaneous coronary intervention (PCI) prior to enrollment (P < 0.0001). As eGFR declined, the proportion of subjects experiencing death versus reduced eGFR or ESRD qualitatively increased. In adjusted analyses, every 10 ml/min/1.73 m2 decrease in eGFR 
90 was associated with a 15% increased hazard of death (HR 1.15, P = 0.01). In adjusted analyses of predictors of percent change in eGFR, catheterization (cath) with or without PCI compared to medical therapy during follow-up was not associated with significant differences in long-term eGFR (P = 0.09).
Conclusions. Among CKD subjects in this study, the risk of death greatly outweighed the risk of reduced eGFR or development of ESRD following ACS and the occurrence of cath ± PCI was not associated with significant differences in long-term renal function. The presence of CKD should not preclude potentially beneficial interventions and research should focus on reducing the high cardiovascular burden in this population.
Keywords: acute coronary syndrome; cardiac catheterization; cardiac interventions; chronic kidney disease; mortality; outcomes
Received for publication: 2. 4.07
Accepted in revised form: 6. 9.07