The Long-term Outcome And Related Risk Factors In Elderly Patients With Coronary Artery Disease And Chronic Kidney Disease

Backgrounds:The increase of aging population leads to an increasing incidence of coronary artery disease (CAD) with chronic kidney disease (CKD). The coexistense of CAD and CKD might mean an adverse outcome and the higher mortality. CKD can increase all-cause mortality in patients with CAD. The prognostic ability of the estimated Glomerular Filtration Rate used the most common Modification of Diet in Renal Disease (MDRD or Chinese Modification of Diet in Renal Disease Study equation) Study equation in CAD and CKD patients with long-term outcome is not yet known clearly. The incidence of anemia in elderly patients with CKD and CAD is very high, and lead to adverse outcomes. Subclinical thyroid disorder (STD) is a major comorbidity among patients with CAD in elderly patients may lead to renal progression or adverse outcomes.Aims:To determine the morbidity and mortality of CKD in Chinese elderly patients with CAD and their baseline related risk factors; to estimate the prognostic ability of two kinds of diseases coexist influence on long-term outcome and analysis related risk factors; To determine the morbidity and mortality of anemia in Chinese elderly patients with CAD and CKD and their baseline related risk factors; to estimate the prognostic ability on long-term outcome and analysis its related risk factors; To determine the morbidity and mortality of STD in Chinese elderly patients with CAD and CKD and their baseline related risk factors; to estimate the prognostic ability on long-term outcome and analysis its related risk factors.Methods:This study included795patients (60years or older) with CAD, whose datas on baseline and follow up characteristics, laboratory examination and equipment inspection were obtained. Thyroid status measurement on serum was conducted in320patients. The principal endpoint was all-cause mortality over the mean follow-up period of10years and the second endpoint was cardiovascular events and renal events.Results:1, The median age of the study population in baseline was79years.220patients had CKD in all. There were many differences between patients with CKD and without CKD. Hemoglobin and other factors were independently associated with the development of CKD.2、The median follow-up of the study was ten years,the total mortality of CAD was32.8%. Patients with CKD at baseline experienced a significantly higher mortality (30.1%) than those without CKD (15.6%).The CKD at baseline as well as anemia and other risk factors were independently correlated with mortality for patients with CAD in ten years follow-up.3、After three year’s follow-up, patients with CKD at baseline experienced a significantly more renal events than those without CKD. The prevalence of creatinine redouble was1.6%. Patients with CKD at baseline experienced a significantly higher incidence (3.6%) of creatinine redouble than those without CKD (0.87%) at baseline. The prevalence of renal progression was2.1%. Patients with CKD at baseline experienced a significantly higher incidence (4.1%) of renal progression than those without CKD (1.4%) at baseline. The baseline hemoglobin as well as other risk factors was associated with increasing risk of renal events, and renal event was independent of CKD at baseline associated with the long-term adverse outcomes.4、The prevalence of anemia at baseline was (44.0%), Patients with CKD at baseline experienced a significantly higher incidence (33.7%) of anemia than those without CKD (22.9%) at baseline.The baseline anemia or hemoglobin was associated with increase the long-term mortality in elderly CAD patients, this risk was independent of other factors. After three year’s follow-up, sustained anemia has the highest mortality, independent of baseline anaemia and hemoglobin level was associated with increasing risk of long-term mortality.5. The median of TSH was1.96mU/l. there were19patients with TSH>10mU/l or TSH<0.1mU/l, the prevalence of subclinical thyroid disorder was5.9%. Patients with CKD at baseline experienced a same incidence (3.6%) of STD as those without CKD at baseline. The BMI at baseline was independently associated with the development of STD. The risk of STD for long-term mortality was not statistically significant, but the risk of STD for renal event was significantly higher than that in patients with normal thyroid function.Conclusions:There was a high prevalence and all-cause mortality of CKD in Chinese elderly patients with CAD. CKD was independently associated with mortality for patients with CAD for long-term. Several characteristics could be used to identify CAD patients at increased risk for CKD or death. Renal progression was independent of CKD at baseline associated with the all-cause mortality for long-term follow-up. Patients with CKD at baseline experienced a significantly higher incidence of anemia. The baseline anemia was associated with increase the long-term mortality in elderly CAD patients. The sustained anemia has the highest mortality, independent of baseline anaemia and hemoglobin level was associated with increasing risk of long-term mortality.