Association of atherosclerotic coronary artery disease and pulse pressure with renal disease progression

This study was performed to identify the association of atherosclerotic coronary artery disease (CAD) and pulse pressure with renal disease progression in patients with mild chronic renal disease. Methods: Eligibility criteria for enrollment in this study included age 18 to 70 years, mild chronic renal disease (CRD), undergoing thallium SPECT and echocardiography and followed longer than 3 years. Mild CRD was defined as serum creatinine level of 1.5 to 3.0 mg/dl in men and 1.4 to 3.0 mg/dl in women. Patients with serious illness, history of kidney transplantation, ejection fraction less than 40% on echocardiography and development of acute renal failure during follow-up were excluded. Results: A total of 87 patients were included in this study. The underlying renal disease included diabetic nephropathy in 51 patients. Forty-five patients showed positive findings on thallium SPECT and they were classified as having CAD. Coronary angiography showed significant stenosis in 41 of 42 patients studied. Median duration of follow-up was 56 months. During the follow-up period, 40 patients required chronic dialysis therapy and 16 patients showed a doubling of baseline serum creatinine in 3 years. These 56 patients were classified as progressors. Comparison of clinical and laboratory parameters between progressors and non-progressors showed a difference in the presence of diabetic nephropathy, mean arterial pressure, 24-hour urine protein (p<0.001), pulse pressure (p<0.0l), total cholesterol and presence of CAD (p<0.05). There was no association between the progression of CRD and the results of CAD or treatment of CAD. Multivariate logistic regression analysis showed that the presence of diabetic nephropathy and mean arterial pressure greater than or equal to 100 mmHg were independent predictors of CRD progression. Conclusion: Atherosclerotic coronary artery disease and pulse pressure were associated with renal disease progression.