Comparative assessment of kidneys’ functional state in patients with acute coronary syndrome

Aim. To determine the severity of chronic kidney disease (CKD) in patients after acute coronary syndrome (ACS).

Material and methods. The study was conducted in Semey (Semipalatinsk), East Kazakhstan region. The case histories of patients with ACS who were admitted to the University Hospital of the State Medical University (Semey State Medical University) of the East Kazakhstan Region for 1 year were studied. A total of 659 case histories were analyzed, of which 263 were patients with myocardial infarction (MI), and 396 were patients with unstable angina (UA). The diagnostic criteria for CKD were: proteinuria, levels of creatinine, glomerular filtration rate (GFR) <60 ml/min/1,73 m2. CKD stage was determined by the parameters of GFR.

Results. The average proteinuria in patients with MI (Me=0,033) were higher than in patients with UA (Me=0,00), U=39564,5, Z=-5,579 p=0,000. The average values of creatinine in patients with MI were 10,26 mmol/l higher than in patients with UA (t=3,333, df=657, p=0,001). The mean GFR values in patients with MI were lower by 4,69 L/min/1,73 m2 than in patients with UA (t=-3,794, df=657, p=0,000. The highest percentage of CKD in patients with ACS were in stage 2-3, the second stage of CKD was more often diagnosed in patients with UA.

Conclusion. The results of study allowed us to characterize the severity of CKD in patients undergoing ACS. We consider that widespread introduction of international and national clinical guidelines on the diagnosis, treatment and prevention of CKD in patients undergoing ACS is needed.

1. Stefanos Foussas. Acute Coronary Syndromes. Hellenic J Cardiol. 2015;56:275-76. https://www.hellenicjcardiol.org/archive/full_text/2015/3/2015_3_275.pdf.

2. Smith JN, Negrelli JM, Manek MB, et al. Diagnosis and Management of Acute Coronary Syndrom. JABFM March–April 2015;28,2. doi:10.3122/jabfm.2015.02.140189.

3. Chang Y, Liu Ch, Tsai L et al. Separate and joint effects of diabetes mellitus and chronic kidney disease on the risk of acute coronary syndrome. Medicine (Baltimore) 2014 Dec; 93(28): e261. doi:10.1097/MD.0000000000000261.

4. Kobalava ZhD, Villevalde SV, Moiseev VS. Cardiovascular disease and renal function Russ J Cardiol. 2013;4(102):33-7. (In Russ.) doi:10.15829/1560-4071-2013-4-33-37.

5. Zykov MV. The course and risk stratification of acute coronary syndrome in conjunction with renal dysfunction and various treatment strategies. Kompleksnye problemy serdechnososudistyh zabolevanij. 2015;3:68-78. (In Russ.) doi:10.17802/2306-1278-2015-3-68-78.

6. Basra SS, Tsai P, Lakkis NM. Safety and efficacy of anticoagulants in kidney disease. JACC. November 2011;22(58):2263-9. doi:10.1016/j.jacc.2011.08.051.

7. Matsushita K, Velde M, Astor BC, et al. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality: a collaborative meta-analysis of general population cohorts. Lancet. 2010;375(9731):2073-81. doi:10.1016/S0140-6736(10)60674-5.

8. Lin TH, Hsin HT, Wang CL, et al. Impact of impaired glomerular filtration rate and revascularization strategy on one-year cardiovascular events in acute coronary syndrome: data from Taiwan acute coronary syndrome full spectrum registry. BMC Nephrology. 2014;15(66):1-9. http://www.biomedcentral.com/1471-2369/15/66.

9. Flores-Blanco PJ, Lopez-Cuenca A, Januzzi JL, et al. Comparison of risk prediction with the CKD-EPI and MDRD equations in non–ST-segment elevation acute coronary syndrome. Clin.Cardiol. 2016;39(9):507-15. doi:10.1002/clc.22556.

10. Ronco C, Cullough P, Anker S, et al. Cardio-renal syndromes: report from the consensus conference of the Acute Dialysis Quality Initiative. Eur Heart J. 2010;31:703-11. doi:10.1093/eurheartj/ehp507.

11. Bart BA, Goldsmith SR, Lee KL, et al. Ultrafiltration in decompensated heart failure with cardiorenal syndrome. N Engl J Med. 2012;367(24):2296-304. doi:10.1056/NEJMoa1210357.

12. Tao R, Fan Q, Zhang H, et al. Prognostic significance of interleukin-34 (IL-34) in patients with chronic heart failure with or without renal insufficiency. J Am Heart Assoc. 2017;6:004911. doi:10.1161/JAHA.116.004911.

13. Choi JS, Kim CS, Bae EH, et al. Suboptimal medical care of patients with ST-elevation myocardial infarction and renal insufficiency: Results from the Korea Acute Myocardial Infarction Registry. BMC Nephrol. 2012;13:110. doi:10.1186/1471-2369-13-110.

14. Campbell NG, Varagunam M, Sawhney V, et al. Mild chronic kidney disease is an independent predictor of long-term mortality after emergency angiography and primary percutaneous intervention in patients with ST-elevation myocardial infarction. Heart. 2012; 98:42-7. doi:10.1136/heartjnl-2011-300024.

15. Liu Y, Gao L, Xue Q, et al. Impact of renal dysfunction on long-term outcomes of elderly patients with acute coronary syndrome: a longitudinal, prospective observational study. BMC Nephrology. 2014;15:78. http:www.biomedcentral.com/1471-2369/15/78.

16. Wybraniec MT, Mizia-Stec K, Więcek A. Contrast-induced acute kidney injury: the dark side of cardiac catheterization. Pol Arch Med Wewn. 2015;125(12):938-49.

17. Lazaros G, Tsiachris D, Tousoulis D, et al. In-hospital worsening renal function is an independent predictor of one-year mortality in patients with acute myocardial infarction. Int J Cardiol. 2012;155:97-101.

18. Cardiovascular risk and chronic kidney disease: cardio-nephroprotection strategies. Recommendations by the Joint Expert Committee RSC, SSRN, RAE, RSH, RNAS, RSSIM. Russian Journal of Cardiology. 2014;(8):7-37. (In Russ.) doi:10.15829/1560-4071-2014-8-7-37.

19. Buargub M, Elmokhtar ZO. Incidence and Mortality of Acute Kidney Injury in Patients with Acute Coronary Syndrome: A Retrospective Study from a Single Coronary Care Unit. Saudi J Kidney Dis Transpl. 2016;27(4):752-7. doi:10.4103/1319-2442.185238.

20. Levey AS, Stevens LA, Schmid CH, et al. A New Equation to Estimate Glomerular Filtration Rate. Ann Intern Med. 2009;150(9):604-12. PMID: 19414839.

21. Chapter 1: Definition and classification of CKD. Kidney International Supplements. 2013;3:19-62. doi:10.1038/kisup.2012.64.

22. Unguryanu TN, Grjibovski AM. Brief recommendations on description, analysis and presentation of data in scientific papers. Ekologiya cheloveka. Human Ecology. 2011;5:55- 60. (In Russ.)

23. Grjibovski AM, Ivanov SV, Gorbatova MA. Analysis of quantitative data in two independent samples using Statistica and SPSS software: parametric and non-parametric tests. Nauka i Zdravookhranenie. Science & Healthcare. 2016;2:5-28. (In Russ.)

24. Kharkova OA, Kholmatova КК, Kuznetsov VN, et al. Qualitative Reserch In Medicine And Public Health. Ekologiya cheloveka. Human Ecology. 2016;12:54-9. (In Russ.)

25. Chao Li, Dayi Hu, Xubo Shi, et al. A Multicentre Prospective Evaluation of the Impact of Renal Insufficiency on In-hospital and Long-term Mortality of Patients with Acute ST-elevation Myocardial Infarction. Chinese Medical Journal. 2015;128(1):1-6. doi:10.4103/0366-6999.147330.

26. Foley RN, Collins AJ. A Novel Model of Cardiovascular Risk Based on Kidney Function. Am J Nephrol. 2011;34:505-11. doi:10.1159/000332997.

27. Milchakov KS, Shilov EM, Shvetzov MYu, et al. Management of chronic kidney disease in the Russian Federation: A critical review of prevalence and preventive programmes, International Journal of Healthcare Management. doi:10.1080/20479700.2018.1453970.

28. Go AS, Chertow GM, Fan D, et al. Chronic kidney dis-ease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351(13):1296-305. doi:10.1056/NEJMoa041031.

29. Tonelli M, Muntner P, Lloyd A, et al. Risk of coronaryevents in people with chronic kidney disease compared with those with diabetes: a population-level cohort study. Lancet. 2012;380(9844):807-14. doi:10.1016/S0140-6736(12)60572-8.

30. Weber C, Beaulieu M, Djurdjev O, et al. Towardsrational approaches of health care utilization in complex patients: an exploratory randomized trial comparing a novel combined clinic to multiple specialty clinics in patients with renal disease-cardiovascular disease-diabetes. Nephrol Dial Transplant. 2012;27(Suppl. 3):iii104-iii110.