European Heart Journal Advance Access originally published online on March 30, 2006
European Heart Journal 2006 27(10):1191-1197; doi:10.1093/eurheartj/ehi846
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Refined characterization of the association between kidney function and mortality in patients undergoing cardiac catheterization
1 Department of Medicine, University of Calgary, Calgary, Alberta, Canada
2 Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
3 Centre for Health and Policy Studies, University of Calgary, Calgary, Alberta, Canada
4 Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
Received 17 December 2005; revised 7 February 2006; accepted 9 March 2006; online publish-ahead-of-print 28 March 2006.
* Corresponding author. Tel: +1 403 944 2745; fax: +1 403 944 2876. E-mail address: brenda.hemmelgarn{at}calgaryhealthregion.ca
Aims Chronic kidney disease is associated with an increased risk of cardiovascular morbidity and mortality. The level of kidney function at which this risk increases remains to be determined. We sought to characterize the relationship between kidney function and survival among patients with cardiovascular disease (CVD) undergoing cardiac catheterization using estimated glomerular filtration rate (eGFR) and graded refinements in the classification of kidney function.
Methods and results We included 8521 of 11 778 (72.3%) consecutive patients undergoing cardiac catheterization between 1 January 1999 and 31 December 2001 from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease database. eGFR as a categorical and continuous variable was used to define kidney function. The outcome was all-cause mortality. During a median (interquartile range) follow-up of 2.2 (1.5–3.1) years, and after adjustment for clinical risk factors and severity of coronary disease, there was a steady incremental decrease in survival post-catheterization corresponding to a decline in eGFR categories of 10 mL/min/1.73 m2. When eGFR was modelled as a continuous variable, there was an increased risk of death noted at an eGFR below 79 mL/min/1.73 m2. Below an eGFR of 70 mL/min/1.73 m,2, there was an approximate 17.2% relative increase in risk for every 10 unit decrease in eGFR (95% CI 8.4–26.6%).
Conclusion The risk of death post-cardiac catheterization is elevated when eGFR is 
79 mL/min/1.73 m2. These findings provide considerable refinement in our understanding of eGFR as a powerful prognostic marker in patients with CVD undergoing cardiac catheterization.
Key Words: Kidney • Coronary disease • Mortality • Epidemiology
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