Abstract 11953: Peripheral Endothelial Function and Cardiovascular Events in Chronic Kidney Disease Patients
Background: Patients with chronic kidney disease (CKD) is the high risk for developing coronary artery disease (CAD) and future cardiovascular events. We hypothesized peripheral endothelial dysfunction assessed by reactive hyperemia peripheral arterial tonometry (RH-PAT) could be associated with the presence of CAD in CKD patients and could be a predictor for future cardiovascular events.
Methods: We enrolled 817 stable patients with at least one coronary risk factor. We assessed the peripheral endothelial function as RH-PAT index (RHI) and examined the presence of CAD by coronary angiography (>75% stenosis), and evaluated the severity and complexity of CAD by Gensini and SYNTAX score. Furthermore, CKD patients were prospectively followed until occurrence of cardiovascular events.
Results: RHI value was significantly attenuated in CKD patients. In CKD patients (n=337), RHI value was significantly lower in CAD patients (n=225) than non-CAD (n=112) (p≤0.001). By multivariate logistic regression analysis, RHI value was independently associated with the presence of CAD (p=0.001). In CKD+CAD patients, RHI value was attenuated in high-Gensini score group (p≤0.001), and high-SYNTAX score group (p≤0.001). By multivariable logistic regression analysis, RHI was independently associated with the severity and complexity of CAD (p≤0.001). During mean 29 months follow up of CKD patients, 76 cardiovascular events were recorded. Multivariate Cox hazard analysis demonstrated lower-RHI value independently predicted future cardiovascular events (Hazard ratio; 0.54, 95% confidence interval 0.32-0.92, p=0.02). The predictive value of adding RHI to Framingham risk score (FRS) was evaluated by net reclassification index (NRI) and C-statistic, which were significantly improved (NRI=0.22%, p=0.005) (C-statistics: FRS 0.50, FRS+RHI 0.59; p=0.01).
Conclusion: Peripheral endothelial function was significantly impaired in CKD. Endothelial dysfunction was correlated with the presence of CAD and an independent factor correlated with the future cardiovascular events in CKD patients. The assessment of endothelial function can provide clinically important information in the risk stratification to identify vulnerable patients among CKD patients.
- © 2013 by American Heart Association, Inc.