ABSTRACT
Chronic renal insufficiency [CRI] is a predictor of stroke, cardiovascular, and all-cause mortality, but the mechanisms responsible for these associations are unclear. Whether CRI was associated with severity of coronary artery disease [CAD]. 230 patients with CRI were subjected to stress echocardiography to evaluate stable CAD. The correlations of various parameters with the prevalence of CAD were also examined. Atherosclerotic surrogate markers, including intima-media thickness of carotid artery and ankle-brachial BP index [ABI], were also evaluated. Renal function was assessed by 24-h urine collection, and CRI was defined as measured creatinine clearance 60 ml/min. Stress echocardiography was used to identify inducible ischemia, defined as any wall motion abnormality seen at stress but not at rest. Logistic regression was used to evaluate the association of CRI with exercise-induced ischemia after adjustment for cardiovascular risk factors. Among the 230 participants, 55 [23.9%] had CAD, and were characterized by older age, lower ejection fraction, greater left ventricular mass and higher C-reactive protein values. The prevalence of exercise-induced ischemia was also substantially greater in the participants with CRI distributed in such way that 20.1% in group I compared with 44.4% group II [odds ratio [OR], 2.3; 95% confidence interval [CI], 1.4 to 3.8; p < 0.01]. After multivariate adjustment, CRI remained strongly associated with exercise-induced ischemia [OR, 2.0; 95% CI, 1.2 to 3.3; p = 0.01]. After further adjustment for CRP, the adjusted association was essentially unchanged [OR, 2.3; 95% CI, 1.0 to 5.1; p <0.05]. Univariate analysis showed that diabetes [p <0.01], left ventricular mass index [p<0.05], hyperlipidemia [p <0.01], total cholesterol [p <0.01], LDL cholesterol [p <0.01], and intima-media thickness [p < 0.01], were positively correlated with the presence of CAD, whereas ABI [p <0.01] showed a negative correlation with CAD. Stepwise logistic regression analysis revealed that diabetes was significant and independent risk factor for CAD in asymptomatic CRI patients. CRI is strongly associated with exercise-induced ischemia in patients with CAD. The greater severity of atherosclerotic disease observed in patients with CRI may in part explain the association of CRI with increased cardiovascular risk among individuals with CAD