Clinical Feature and Outcome of Angiographic Coronary Artery Disease in Chronic Kidney Disease Patients

NCT00651521 | Unknown DMC

• 2 other identifiers: IWW-0002CGMH-IRB-96-1680B
• Study Type: observational
• Target: 1,000
• Locations: 1 country
• Sites: 1

Brief Summary

The prevalence and mortality rate of cardiovascular disease (CVD) in chronic kidney disease (CKD) patients is high. The prevalence of coronary artery disease (CAD) in CKD population ranges from 38 to 65%, with an average of 3.3 coronary lesions per person. The relative risk for death from myocardial infarction and CAD is 1.18 in CKD patients with GFR \< 60 ml/min. Because of this high prevalence of CAD and its high mortality, reducing and preventing CAD risk factors is crucial in the clinical management of CKD patients. Low glomerular filtration rate (GFR) constitutes an important independent risk factor for CAD. Several pathogenic factors play role in the genesis of cardiovascular dysfunction in chronic kidney disease. Increased traditional CAD risk factor, endothelial dysfunction, sympathetic hyperactivity, renin-angiotensin system activation, increased glycosylated end products, all contribute to the characteristic medial calcification of cardiovascular disease in CKD patients. Hypertension, fluid overloading and anemia further aggravated the cardiac loading, leading to myocardial hypertrophy with chamber dilatation, heart failure and death. The mortality rate of CAD in CKD patients is extremely high. The NHANES II (National Health and Nutritional Evaluation Survey) found an increased of mortality rate\> 51%, when the GFR decreased from \> 90 to \< 70 ml/min. The 1-year mortality rate in different CKD stage were 0.7% (normal renal function patients), 2.0% (patients with proteinuria), 3.5% (overt proteinuric patients) and 12.1% (dialysis patients), respectively. However, the clinical feature and outcome of CAD in different stage of CKD remains unclear. We conducted a retrospective cohort study involving all patients admitted for coronary angiography from 1992 to 2004. The patients were categorized into five stages of CAD to compare the risk factor, clinical feature and outcome. Determination of this relationship can help to establish factors for early detection of CAD in CKD patients and also prognostic factor to improve outcome of these patients.

Conditions

Coronary Artery Disease; Chronic Kidney Disease

Keywords

Angiographic CAD; Chronic kidney disease; Left ventricular dysfunction; Body mass index; Cardiovascular mortality; Coronary angiography

Outcome Measures

Primary Outcomes (2)

• all cause death

  number of death

  10 years

• change of renal function

  number to dialysis

  10 years

Study Arms (6)

1

CKD stage 1 patients

2

CKD stage 2 patients

3

CKD stage 3a patients

4

CKD stage 3b patients

5

CKD stage 4 patients

6

CKD stage 5 patients

Eligibility Criteria

• Age: 18 Years - 85 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

All CKD patients admitted for coronary angiography from 1992 to 2019. The patients were further categorized into five stages of CKD.

You may qualify if:

• CKD patients with typical angina or positive electrocardiographic finding for myocardia ischemia.
• Aged 20-80 years.

You may not qualify if:

• \. recipient of renal transplant graft or dialysis therapy

Sponsors & Collaborators

• Chang Gung Memorial Hospital: lead

Study Sites (1)

Department of Nephrology,Chang Gung Memorial Hospital

Keelung, 240, Taiwan

Location

Related Publications (6)

• Aronow WS, Ahn C, Mercando AD, Epstein S. Prevalence of coronary artery disease, complex ventricular arrhythmias, and silent myocardial ischemia and incidence of new coronary events in older persons with chronic renal insufficiency and with normal renal function. Am J Cardiol. 2000 Nov 15;86(10):1142-3, A9. doi: 10.1016/s0002-9149(00)01176-0.

  PMID: 11074216 BACKGROUND

• Reddan DN, Szczech L, Bhapkar MV, Moliterno DJ, Califf RM, Ohman EM, Berger PB, Hochman JS, Van de Werf F, Harrington RA, Newby LK. Renal function, concomitant medication use and outcomes following acute coronary syndromes. Nephrol Dial Transplant. 2005 Oct;20(10):2105-12. doi: 10.1093/ndt/gfh981. Epub 2005 Jul 19.

  PMID: 16030030 BACKGROUND

• Reddan DN, Szczech LA, Tuttle RH, Shaw LK, Jones RH, Schwab SJ, Smith MS, Califf RM, Mark DB, Owen WF Jr. Chronic kidney disease, mortality, and treatment strategies among patients with clinically significant coronary artery disease. J Am Soc Nephrol. 2003 Sep;14(9):2373-80. doi: 10.1097/01.asn.0000083900.92829.f5.

  PMID: 12937316 BACKGROUND

• Reis SE, Olson MB, Fried L, Reeser V, Mankad S, Pepine CJ, Kerensky R, Merz CN, Sharaf BL, Sopko G, Rogers WJ, Holubkov R. Mild renal insufficiency is associated with angiographic coronary artery disease in women. Circulation. 2002 Jun 18;105(24):2826-9. doi: 10.1161/01.cir.0000021597.63026.65.

  PMID: 12070108 BACKGROUND

• Stack AG. Coronary artery disease and peripheral vascular disease in chronic kidney disease: an epidemiological perspective. Cardiol Clin. 2005 Aug;23(3):285-98. doi: 10.1016/j.ccl.2005.04.003.

  PMID: 16084278 BACKGROUND

• Keough-Ryan TM, Kiberd BA, Dipchand CS, Cox JL, Rose CL, Thompson KJ, Clase CM. Outcomes of acute coronary syndrome in a large Canadian cohort: impact of chronic renal insufficiency, cardiac interventions, and anemia. Am J Kidney Dis. 2005 Nov;46(5):845-55. doi: 10.1053/j.ajkd.2005.07.043.

  PMID: 16253724 BACKGROUND

MeSH Terms

Conditions

Coronary Artery Disease; Renal Insufficiency, Chronic; Ventricular Dysfunction, Left

Condition Hierarchy (Ancestors)

Coronary Disease; Myocardial Ischemia; Heart Diseases; Cardiovascular Diseases; Arteriosclerosis; Arterial Occlusive Diseases; Vascular Diseases; Renal Insufficiency; Kidney Diseases; Urologic Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Male Urogenital Diseases; Chronic Disease; Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Ventricular Dysfunction

Study Officials

• Iwen Wu, MD

  Chang Gung Memorial Hospital

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: RETROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Attending physician

Study Record Dates

• First Submitted: March 30, 2008
• First Posted: April 2, 2008
• Study Start: April 1, 2009
• Primary Completion: March 1, 2022
• Study Completion: March 1, 2025
• Last Updated: March 10, 2020

Record last verified: 2020-03

Locations

TW (1)