Published Online
on April 22, 2002

A more recent version of this article appeared on May 14, 2002

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Submitted on December 27, 2001
Revised on March 6, 2002
Accepted on March 6, 2002

Outcomes of Patients With Chronic Renal Insufficiency in the Bypass Angioplasty Revascularization Investigation

L. A. Szczech MD, MSCE^*, P. J. Best MD, E. Crowley PhD, M. M. Brooks PhD, P. B. Berger MD, V. Bittner MD, B. J. Gersh MD, R. Jones MD, R. M. Califf MD, H. H. Ting MD, P. J. Whitlow MD, K. M. Detre PhD, D. Holmes MD, and for the Bypass Angioplasty Revascularization Investigation (BARI) Investigators

From Duke University Medical Center (L.A.S.), Division of Nephrology, Durham, NC; Mayo Clinic (P.J.B., P.B.B., B.J.G., H.H.T., D.H.), Division of Cardiology, Minneapolis, Minn; University of Pittsburgh (E.C., M.M.B., K.M.D.), Division of Cardiology, Pittsburgh, Pa; University of Alabama (V.B.), Division of Cardiology, Birmingham, Ala; Duke Clinical Research Institute (R.J., R.M.C.), Duke University Medical Center, Durham, NC; and Cleveland Clinic (P.J.W.), Division of Cardiology, Cleveland, Ohio.

^* To whom correspondence should be addressed. E-mail: szcze001{at}mc.duke.edu.

Background—Although severe chronic kidney disease (CKD) is an independent predictor of mortality among patients with coronary artery disease, the impact of mild CKD on morbidity and mortality has not been fully defined.

Methods and Results—Morbidity and mortality for the 3608 patients with multivessel coronary artery disease enrolled in the Bypass Angioplasty Revascularization Investigation randomized trial and registry were compared on the basis of the presence and absence of CKD, defined as a preprocedure serum creatinine level of >1.5 mg/dL. Seventy-six patients had CKD. Patients with renal insufficiency were older and more likely to have a history of diabetes, hypertension, and other comorbidities. Among patients undergoing PTCA, patients with CKD had a greater frequency of in-hospital death and cardiogenic shock (P<0.05 and 0.01, respectively). There was a trend toward a larger proportion of patients with CKD experiencing angina at 5 years (P=0.079). Patients with CKD had more cardiac admissions (P=0.003 and <0.0001 for patients undergoing PTCA and CABG, respectively) and a shorter time to subsequent CABG after initial revascularization than patients without CKD (P=0.01). CKD was associated with a higher risk of death at 7 years, both of all causes (relative risk 2.2, P<0.001) and of cardiac causes (relative risk 2.8, P<0.001).

Conclusions—CKD is associated with an increased risk of recurrent hospitalization, subsequent CABG, and mortality. This increased risk of death is independent of and additive to the risk associated with diabetes.

Key words: kidney • coronary disease • mortality

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