Abstract 13028: Association of Peripheral Endothelial Function and Coronary Artery Disease in Patients with Chronic Kidney disease
Background: Patients with chronic kidney disease (CKD) have an increased risk for developing coronary artery disease (CAD), however all CKD patients were not equally predisposed to CAD. In the aging society, CKD patients have been increasing year by year and the risk stratification in patients with CKD is clinically important. Endothelial dysfunction has been implicated in CAD and digital assessment of endothelial function by reactive hyperemia peripheral arterial tonometry (RH-PAT) is a noninvasive and operator-independent clinical examination to evaluate endothelial function. We hypothesized that the peripheral endothelial dysfunction could be associated with the presence of CAD in patients with CKD.
Methods: We enrolled 1002 stable patients with at least one coronary risk factor (diabetes [29.6%], hypertension [81.1%], current smoking [19.0%], dyslipidemia [73.0%], family history of CAD [19.8%]). We assessed the peripheral endothelial function as RH-PAT index (RHI) by measuring fingertip RH-PAT using Endo-PAT2000 and examined the presence of CAD by coronary angiography (>75% stenosis).
Results: RHI values were significantly attenuated in CKD patients (CKD stage-III [n=300], -IV [n=29], -V [n=4], n=333) compared to non-CKD patients (n=669) (RHI: CKD 0.51±0.18 vs. non-CKD 0.57±0.22, p<0.001). In patients with CKD, RHI values were significantly lower in patients with CAD (n=231) than non-CAD patients (n=80) (RHI: CKD+CAD; 0.49±0.17 vs. CKD+non-CAD; 0.58±0.21, p<0.001). In receiver-operating characteristic analysis, RHI had significant correlation with the presence of CAD (area under the curve 0.62, 95% confidence interval 0.55-0.69, p=0.001). By multivariate backward logistic regression analysis among various risk factors, RHI was independently associated with the presence of CAD in patients with CKD (odds ratio 1.29, 95% confidence interval 1.12-1.49; p<0.001).
Conclusion: Endothelial function was significantly impaired in patients with CKD and the advanced endothelial dysfunction was significantly correlated with the presence of CAD in CKD patients. The assessment of endothelial function can provide clinically important information in the risk stratification to identify vulnerable patients among patients with CKD.
- © 2012 by American Heart Association, Inc.