Hemmelgarn BR, Southern DA, Humphries KH, Culleton BF, Knudtson ML, Ghali WA for the APPROACH Investigators. Refined characterization of the association between kidney function and mortality in patients undergoing cardiac catheterization. Eur Heart J 2006 May;27(10):1191-7.

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 8,521 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 m 2. 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 m 2. 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 m 2. These findings provide considerable refinement in our understanding of eGFR as a powerful prognostic marker in patients with CVD undergoing cardiac catheterization.

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