Declining renal function after myocardial infarction predicts poorer long-term outcome

Introduction In-hospital decline in renal function during the immediate post myocardial infarction (MI) period is known to predict poorer outcome; subsequent chronic change in renal function is less well reported. This study sought to track long-term change in renal function after MI, and assess its correlation with the outcome. Methods and results Individuals who had sustained a first validated MI in the preceding 2.5-11.5 years were identified from the monitoring of trends and determinants in cardiovascular disease (MONICA) register and were invited to undergo a screening process in 1995, and again in 1998. All deaths were recorded up to the end of 2006. Change in renal function between 1995 and 1998 was available for 500 individuals (mean age 61.6 +/- 7.3 years, 74.8% men). Change in (D) calculated estimated glomerular filtration rate (eGFR) was normally distributed, with a mean crude fall in eGFR of 1.91 +/- 9.47 ml/min per 1.73m(2). This corresponded to a -1.9 +/- 13.3% change in eGFR, or -0.8 +/- 3.6 ml/min/1.73 m(2) per year. D eGFR correlated negatively with baseline eGFR (r=l-0.307, P < 0.001). The first tertile (with the largest decline in eGFR) had an adjusted hazard ratios of 1.86 (1.14-3.03) for all cause mortality and 2.06 (1.13-3.74) for cardiovascular death, compared to the third tertile. A rise in creatinine of greater than 0.3 mg/dl carried adjusted hazard ratios of 2.27 (1.13-4.57) and 3.61 (1.73-7.54) for all cause mortality and cardiovascular death, respectively. Conclusion Chronic change in renal function after MI is predictive of long-term prognosis. Eur J Cardiovasc Prev Rehabil 17: 181-186 (C) 2010 The European Society of Cardiolog

Cardiovascular and renal protective role of angiotensin blockade in hypertension with advanced CKD: a subgroup analysis of ATTEMPT-CVD randomized trial

Abstract The ATTEMPT-CVD study was prospective randomized active-controlled trial and the main findings had been reported. According to baseline GFR and albuminuria categories, we divided the patients of the ATTEMPT-CVD study into 2 subgroups: (Group 1) the patients with at least one of eGFR of <45 ml/min per 1.73 m2 and UACR of ≥300 mg/g creatinine, defined as G3b and/or A3; (Group 2) the patients except for Group 1, defined as the other patients. In patients with G3b and/or A3, the incidence of cardiovascular events was significantly less in ARB group than in non-ARB group (11 vs 22, respectively) (HR = 0.465: 95%CI = 0.224–0.965; P = 0.040). UACR was significantly less in ARB group than in non-ARB group during follow-up period in patients with G3b and/or A3 (P = 0.0003), while eGFR, plasma BNP levels, and blood pressure were comparable between ARB and non-ARB groups. Allocation to ARB therapy was a significant independent prognostic factor for cardiovascular events in patients with G3b and/or A3 (P = 0.0268). On the other hand, in the other patients, the occurrence of cardiovascular events was comparable between ARB and non-ARB groups. In patients with advanced CKD, ARB-based therapy may confer greater benefit in prevention of cardiovascular events than non-ARB therapy