Acute decline in renal function, inflammation, and cardiovascular risk after an acute coronary syndrome

Lisa M. Mielniczuk, Marc A. Pfeffer, Eldrin F. Lewis, Michael A. Blazing, James A de Lemos, Satishkumar Mohanavelu, Jean Rouleau, Keith Fox, Terje R. Pedersen, Robert M. Califf

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21 Scopus citations

Abstract

Background and objectives: Chronic kidney disease is associated with a higher risk of cardiovascular outcomes. The prognostic significance of worsening renal function has also been shown in various cohorts of cardiac disease; however, the predictors of worsening renal function and the contribution of inflammation remains to be established. Design, setting, participants, & measurements: Worsening renal function was defined as a 25% or more decrease in estimated GFR (eGFR) over a 1-mo period in patients after a non-ST or ST elevation acute coronary syndromes participating in the Aggrastat-to-Zocor Trial; this occurred in 5% of the 3795 participants. Results: A baseline C-reactive protein (CRP) in the fourth quartile was a significant predictor of developing worsening renal function (odds ratio, 2.48; 95% confidence interval, 1.49, 4.14). After adjusting for baseline CRP and eGFR, worsening renal function remained a strong multivariate predictor for the combined cardiovascular composite of CV death, recurrent myocardial infarction (MI), heart failure or stroke (hazard ratio, 1.6; 95% confidence interval, 1.1, 2.3). Conclusions: Patients with an early decline in renal function after an acute coronary syndrome are at a significant increased risk for recurrent cardiovascular events. CRP is an independent predictor for subsequent decline in renal function and reinforces the idea that inflammation may be related to the pathophysiology of progressive renal disease.

Original languageEnglish (US)
Pages (from-to)1811-1817
Number of pages7
JournalClinical Journal of the American Society of Nephrology
Volume4
Issue number11
DOIs
StatePublished - Jan 1 2009

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ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

Cite this

Mielniczuk, L. M., Pfeffer, M. A., Lewis, E. F., Blazing, M. A., de Lemos, J. A., Mohanavelu, S., Rouleau, J., Fox, K., Pedersen, T. R., & Califf, R. M. (2009). Acute decline in renal function, inflammation, and cardiovascular risk after an acute coronary syndrome. Clinical Journal of the American Society of Nephrology, 4(11), 1811-1817. https://doi.org/10.2215/CJN.03510509