This Article Figures Only Full Text Full Text (PDF) Correction (v38,p1275) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by McCullough, P. A. Articles by Borzak, S. Search for Related Content PubMed PubMed Citation Articles by McCullough, P. A. Articles by Borzak, S.

CLINICAL STUDY

Risks associated with renal dysfunction in patients in the coronary care unit

^a Henry Ford Health System, Department of Internal Medicine,, Detroit, Michigan, USA
^b Division of Cardiovascular Disease, Detroit, Michigan, USA
^c Division of Hypertension and Nephrology,, Detroit, Michigan, USA
^d Henry Ford Heart and Vascular Institute, Detroit, Michigan., USA

Manuscript received August 10, 1999; revised manuscript received March 1, 2000, accepted April 13, 2000.

Reprint requests and correspondence: Dr. Peter A. McCullough, Cardiovascular Division, Henry Ford Hospital, Henry Ford Heart and Vascular Institute, William Clay Ford Center for Athletic Medicine, 6525 Second Avenue, Detroit, Michigan 48202
pmc975{at}yahoo.com

OBJECTIVES

The purpose of this study was to quantify the impact of baseline renal dysfunction on morbidity and mortality in patients in the coronary care unit (CCU).

BACKGROUND

The presence of renal dysfunction is an established independent predictor of survival after acute myocardial infarction and revascularization procedures.

METHODS

We analyzed a prospective CCU registry of 12,648 admissions by 9,557 patients over eight years at a single, tertiary center. Admission serum creatinine was available in 9,544 patients. Those not on long-term dialysis were classified into quartiles of corrected creatinine clearance, with cut-points of 46.2, 63.1 and 81.5 ml/min per 72 kg. Dialysis patients (n = 527) were considered as a fifth comparison group.

RESULTS

Baseline characteristics, including older age, African-American race, diabetes, hypertension, previous coronary disease and heart failure, were incrementally more common across increasing renal dysfunction strata. There were graded increases in the relative risk for atrial and ventricular arrhythmias, heart block, asystole, development of pulmonary congestion, acute mitral regurgitation and cardiogenic shock across the risk strata. Survival analysis demonstrated an early mortality hazard for those with renal dysfunction, but not on dialysis, for the first 60 months, followed by graded decrements in survival across increasing renal dysfunction strata.

CONCLUSIONS

Baseline renal function is a powerful predictor of short- and long-term events in the CCU population. There is an early hazard for in-hospital and postdischarge mortality for those with a corrected creatinine clearance <46.2 ml/min per kg, but not on dialysis.

Abbreviations and Acronyms   AMI = acute myocardial infarction   BUN = blood urea nitrogen   CHF = congestive heart failure   cCrCl = corrected creatinine clearance   CI = confidence interval   CCU = coronary care unit   ECG = electrocardiogram   LVH = left ventricular hypertrophy   RR = relative risk   UAP = unstable angina pectoris

This article has been cited by other articles:

				K. Szummer, P. Lundman, S. H. Jacobson, S. Schon, J. Lindback, U. Stenestrand, L. Wallentin, T. Jernberg, and for SWEDEHEART Influence of Renal Function on the Effects of Early Revascularization in Non-ST-Elevation Myocardial Infarction: Data From the Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART) Circulation, September 8, 2009; 120(10): 851 - 858. [Abstract] [Full Text] [PDF]

				G. Yahalom, R. Schwartz, Y. Schwammenthal, O. Merzeliak, M. Toashi, D. Orion, B.-A. Sela, and D. Tanne Chronic Kidney Disease and Clinical Outcome in Patients With Acute Stroke Stroke, April 1, 2009; 40(4): 1296 - 1303. [Abstract] [Full Text] [PDF]

				T. Keller, C. M. Messow, E. Lubos, V. Nicaud, P. S. Wild, H. J. Rupprecht, C. Bickel, S. Tzikas, D. Peetz, K. J. Lackner, et al. Cystatin C and cardiovascular mortality in patients with coronary artery disease and normal or mildly reduced kidney function: results from the AtheroGene study Eur. Heart J., February 1, 2009; 30(3): 314 - 320. [Abstract] [Full Text] [PDF]

				C. Medi, G. Montalescot, A. Budaj, K. A.A. Fox, J. Lopez-Sendon, G. FitzGerald, D. B. Brieger, and on behalf of the GRACE Investigators Reperfusion in Patients With Renal Dysfunction After Presentation With ST-Segment Elevation or Left Bundle Branch Block: GRACE (Global Registry of Acute Coronary Events) J. Am. Coll. Cardiol. Intv., January 1, 2009; 2(1): 26 - 33. [Abstract] [Full Text] [PDF]

				B. C. Astor, S. I. Hallan, E. R. Miller III, E. Yeung, and J. Coresh Glomerular Filtration Rate, Albuminuria, and Risk of Cardiovascular and All-Cause Mortality in the US Population Am. J. Epidemiol., May 15, 2008; 167(10): 1226 - 1234. [Abstract] [Full Text] [PDF]

				L. G. Glynn, D. Reddan, J. Newell, J. Hinde, B. Buckley, and A. W. Murphy Chronic kidney disease and mortality and morbidity among patients with established cardiovascular disease: a West of Ireland community-based cohort study Nephrol. Dial. Transplant., September 1, 2007; 22(9): 2586 - 2594. [Abstract] [Full Text] [PDF]

				P. A. McCullough, C. T. Jurkovitz, P. E. Pergola, J. B. McGill, W. W. Brown, A. J. Collins, S.-C. Chen, S. Li, A. Singh, K. C. Norris, et al. Independent Components of Chronic Kidney Disease as a Cardiovascular Risk State: Results From the Kidney Early Evaluation Program (KEEP) Arch Intern Med, June 11, 2007; 167(11): 1122 - 1129. [Abstract] [Full Text] [PDF]

				S. G. Wannamethee, A. G. Shaper, G. D.O. Lowe, L. Lennon, A. Rumley, and P. H. Whincup Renal function and cardiovascular mortality in elderly men: the role of inflammatory, procoagulant, and endothelial biomarkers Eur. Heart J., December 2, 2006; 27(24): 2975 - 2981. [Abstract] [Full Text] [PDF]

				L. D. Dworkin Controversial Treatment of Atherosclerotic Renal Vascular Disease: The Cardiovascular Outcomes in Renal Atherosclerotic Lesions Trial Hypertension, September 1, 2006; 48(3): 350 - 356. [Full Text] [PDF]

				B. R. Hemmelgarn, D. A. Southern, K. H. Humphries, B. F. Culleton, M. L. Knudtson, W. A. Ghali, and for the Alberta Provincial Project for Outcomes As Refined characterization of the association between kidney function and mortality in patients undergoing cardiac catheterization Eur. Heart J., May 2, 2006; 27(10): 1191 - 1197. [Abstract] [Full Text] [PDF]

				C. Meisinger, A. Doring, H. Lowel, and for the KORA Study Group Chronic kidney disease and risk of incident myocardial infarction and all-cause and cardiovascular disease mortality in middle-aged men and women from the general population Eur. Heart J., May 2, 2006; 27(10): 1245 - 1250. [Abstract] [Full Text] [PDF]

				F. Brigadeau, C. Kouakam, D. Klug, C. Marquie, A. Duhamel, F. Mizon-Gerard, D. Lacroix, and S. Kacet Clinical predictors and prognostic significance of electrical storm in patients with implantable cardioverter defibrillators Eur. Heart J., March 2, 2006; 27(6): 700 - 707. [Abstract] [Full Text] [PDF]

				R. de Silva, N. P. Nikitin, K. K.A. Witte, A. S. Rigby, K. Goode, S. Bhandari, A. L. Clark, and J. G.F. Cleland Incidence of renal dysfunction over 6 months in patients with chronic heart failure due to left ventricular systolic dysfunction: contributing factors and relationship to prognosis Eur. Heart J., March 1, 2006; 27(5): 569 - 581. [Abstract] [Full Text] [PDF]

				D. G., I. I., N. E., A. E.D., M. G.S., K. N.N., L. A.J., M. I., S. G.W., M. J.W., et al. Radiocontrast-Induced Acute Renal Failure--Impact beyond the Acute Phase: Contrast-Induced Nephropathy after Percutaneous Coronary Interventions in Relation to Chronic Kidney Disease and Hemodynamic Variables. Am J Cardiol 95: 13-19, 2005 J. Am. Soc. Nephrol., March 1, 2006; 17(3): 595 - 599. [Full Text] [PDF]

				N. A. Khan, I. Ma, C. R. Thompson, K. Humphries, D. N. Salem, M. J. Sarnak, and A. Levin Kidney Function and Mortality among Patients with Left Ventricular Systolic Dysfunction J. Am. Soc. Nephrol., January 1, 2006; 17(1): 244 - 253. [Abstract] [Full Text] [PDF]

				J.-P. Collet, G. Montalescot, G. Agnelli, F. Van de Werf, E. P. Gurfinkel, J. Lopez-Sendon, C. V. Laufenberg, M. Klutman, N. Gowda, D. Gulba, et al. Non-ST-segment elevation acute coronary syndrome in patients with renal dysfunction: benefit of low-molecular-weight heparin alone or with glycoprotein IIb/IIIa inhibitors on outcomes. The Global Registry of Acute Coronary Events Eur. Heart J., November 1, 2005; 26(21): 2285 - 2293. [Abstract] [Full Text] [PDF]

				P. A. McCullough Effect of Lipid Modification on Progression of Coronary Calcification J. Am. Soc. Nephrol., November 1, 2005; 16(11_suppl_2): S115 - S119. [Abstract] [Full Text] [PDF]

				R. Vanholder, Z. Massy, A. Argiles, G. Spasovski, F. Verbeke, N. Lameire, and for the European Uremic Toxin Work Group (EUTox) Chronic kidney disease as cause of cardiovascular morbidity and mortality Nephrol. Dial. Transplant., June 1, 2005; 20(6): 1048 - 1056. [Abstract] [Full Text] [PDF]

				J. D. Sackner-Bernstein, H. A. Skopicki, and K. D. Aaronson Risk of Worsening Renal Function With Nesiritide in Patients With Acutely Decompensated Heart Failure Circulation, March 29, 2005; 111(12): 1487 - 1491. [Abstract] [Full Text] [PDF]

				A. T. Yan, R. T. Yan, M. Tan, C.-M. Chow, D. Fitchett, E. Stanton, A. Langer, S. G. Goodman, and for the Canadian Acute Coronary Syndromes Registr Troponin is more useful than creatine kinase in predicting one-year mortality among acute coronary syndrome patients Eur. Heart J., November 2, 2004; 25(22): 2006 - 2012. [Abstract] [Full Text] [PDF]

				G. Marenzi, G. Lauri, E. Assanelli, J. Campodonico, M. De Metrio, I. Marana, M. Grazi, F. Veglia, and A. L. Bartorelli Contrast-induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction J. Am. Coll. Cardiol., November 2, 2004; 44(9): 1780 - 1785. [Abstract] [Full Text] [PDF]

				C Mueller, F-J Neumann, A P Perruchoud, and H J Buettner Renal function and long term mortality after unstable angina/non-ST segment elevation myocardial infarction treated very early and predominantly with percutaneous coronary intervention Heart, August 1, 2004; 90(8): 902 - 907. [Abstract] [Full Text] [PDF]

				C. E. Buller, J. G. Nogareda, K. Ramanathan, D. R. Ricci, O. Djurdjev, K. J. Tinckam, I. M. Penn, R. S. Fox, L. A. Stevens, J. A. Duncan, et al. The profile of cardiac patients with renal artery stenosis J. Am. Coll. Cardiol., May 5, 2004; 43(9): 1606 - 1613. [Abstract] [Full Text] [PDF]

				D. E. Weiner, H. Tighiouart, M. G. Amin, P. C. Stark, B. MacLeod, J. L. Griffith, D. N. Salem, A. S. Levey, and M. J. Sarnak Chronic Kidney Disease as a Risk Factor for Cardiovascular Disease and All-Cause Mortality: A Pooled Analysis of Community-Based Studies J. Am. Soc. Nephrol., May 1, 2004; 15(5): 1307 - 1315. [Abstract] [Full Text] [PDF]

				L. M. Ruilope New European guidelines for management of hypertension: what is relevant for the nephrologist Nephrol. Dial. Transplant., March 1, 2004; 19(3): 524 - 528. [Full Text] [PDF]

				D. E. Forman, J. Butler, Y. Wang, W. T. Abraham, C. M. O'Connor, S. S. Gottlieb, E. Loh, B. M. Massie, M. W. Rich, L. W. Stevenson, et al. Incidence, predictors at admission, and impact of worsening renal function among patients hospitalized with heart failure J. Am. Coll. Cardiol., January 7, 2004; 43(1): 61 - 67. [Abstract] [Full Text] [PDF]

				M. J. Sarnak, A. S. Levey, A. C. Schoolwerth, J. Coresh, B. Culleton, L. L. Hamm, P. A. McCullough, B. L. Kasiske, E. Kelepouris, M. J. Klag, et al. Kidney Disease as a Risk Factor for Development of Cardiovascular Disease: A Statement From the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention Hypertension, November 1, 2003; 42(5): 1050 - 1065. [Full Text] [PDF]

				M. J. Sarnak, A. S. Levey, A. C. Schoolwerth, J. Coresh, B. Culleton, L. L. Hamm, P. A. McCullough, B. L. Kasiske, E. Kelepouris, M. J. Klag, et al. Kidney Disease as a Risk Factor for Development of Cardiovascular Disease: A Statement From the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention Circulation, October 28, 2003; 108(17): 2154 - 2169. [Full Text] [PDF]

				D. N. Reddan, L. A. Szczech, R. H. Tuttle, L. K. Shaw, R. H. Jones, S. J. Schwab, M. S. Smith, R. M. Califf, D. B. Mark, and W. F. Owen Jr. Chronic Kidney Disease, Mortality, and Treatment Strategies among Patients with Clinically Significant Coronary Artery Disease J. Am. Soc. Nephrol., September 1, 2003; 14(9): 2373 - 2380. [Abstract] [Full Text] [PDF]

				A. Levin The advantage of a uniform terminology and staging system for chronic kidney disease (CKD) Nephrol. Dial. Transplant., August 1, 2003; 18(8): 1446 - 1451. [Full Text] [PDF]

				A. Levin The advantage of a uniform terminology and staging system for chronic kidney disease (CKD) Nephrol. Dial. Transplant., August 1, 2003; 18(88): 1446 - 1451. [Full Text]

				C. Stigant, L. Stevens, and A. Levin Nephrology: 4. Strategies for the care of adults with chronic kidney disease Can. Med. Assoc. J., June 10, 2003; 168(12): 1553 - 1560. [Full Text] [PDF]

				R. V. Freeman, R. H. Mehta, W. Al Badr, J. V. Cooper, E. Kline-Rogers, and K. A. Eagle Influence of concurrent renal dysfunction on outcomes of patients with acute coronary syndromes and implications of the use of glycoprotein IIb/IIIa inhibitors J. Am. Coll. Cardiol., March 5, 2003; 41(5): 718 - 724. [Abstract] [Full Text] [PDF]

				P. A. McCullough Why is chronic kidney disease the "spoiler" for cardiovascular outcomes? J. Am. Coll. Cardiol., March 5, 2003; 41(5): 725 - 728. [Full Text] [PDF]

				J.F.E Mann, I Dulau-Florea, and J Franke Looking for people at high cardiovascular risk? Look at serum-creatinine Eur. Heart J., March 1, 2003; 24(5): 381 - 383. [Full Text] [PDF]

				H.L. Hillege, W.H. van Gilst, D.J. van Veldhuisen, G. Navis, D.E. Grobbee, P.A. de Graeff, and D. de Zeeuw Accelerated decline and prognostic impact of renal function after myocardial infarction and the benefits of ACE inhibition: the CATS randomized trial Eur. Heart J., March 1, 2003; 24(5): 412 - 420. [Abstract] [Full Text] [PDF]

				L.K Newby, M.V Bhapkar, H.D White, E.J Topol, F.C Dougherty, R.A Harrington, M.C Smith, L.F Asarch, R.M Califf, and for the SYMPHONY and 2nd SYMPHONY Investigators Predictors of 90-day outcome in patients stabilized after acute coronary syndromes Eur. Heart J., January 2, 2003; 24(2): 172 - 181. [Abstract] [Full Text] [PDF]

				G. Manjunath, H. Tighiouart, H. Ibrahim, B. MacLeod, D. N. Salem, J. L. Griffith, J. Coresh, A. S. Levey, and M. J. Sarnak Level of kidney function as a risk factor for atherosclerotic cardiovascular outcomes in the community J. Am. Coll. Cardiol., January 1, 2003; 41(1): 47 - 55. [Abstract] [Full Text] [PDF]

				P. A. McCullough, R. M. Nowak, C. Foreback, G. Tokarski, M. C. Tomlanovich, N. Khoury, W. D. Weaver, K. R. Sandberg, and J. McCord Emergency Evaluation of Chest Pain in Patients With Advanced Kidney Disease Arch Intern Med, November 25, 2002; 162(21): 2464 - 2468. [Abstract] [Full Text] [PDF]

				P. A McCullough, K. R Sandberg, J. Yee, and M. P Hudson Mortality benefit of angiotensin-converting enzyme inhibitors after cardiac events in patients with end-stage renal disease Journal of Renin-Angiotensin-Aldosterone System, September 1, 2002; 3(3): 188 - 191. [Abstract] [PDF]

				D. N. Reddan and P. S. Klassen Chronic Kidney Disease and Cardiovascular Risk: Time to Focus on Therapy J. Am. Soc. Nephrol., September 1, 2002; 13(9): 2415 - 2416. [Full Text] [PDF]

				S. S. Soman, K. R. Sandberg, S. Borzak, M. P. Hudson, J. Yee, and P. A. McCullough The Independent Association of Renal Dysfunction and Arrhythmias in Critically Ill Patients* Chest, August 1, 2002; 122(2): 669 - 677. [Abstract] [Full Text] [PDF]

				C.R. Sorensen, B. Brendorp, C. Rask-Madsen, L. Kober, E. Kjoller, and C. Torp-Pedersen The prognostic importance of creatinine clearance after acute myocardial infarction Eur. Heart J., June 2, 2002; 23(12): 948 - 952. [Abstract] [Full Text] [PDF]

				R. S. MacWalter, S. Y.S. Wong, K. Y.K. Wong, G. Stewart, C. G. Fraser, H. W. Fraser, Y. Ersoy, S. A. Ogston, and R. Chen Does Renal Dysfunction Predict Mortality After Acute Stroke?: A 7-Year Follow-Up Study Stroke, June 1, 2002; 33(6): 1630 - 1635. [Abstract] [Full Text] [PDF]

				L.A. Szczech, P.J. Best, E. Crowley, M.M. Brooks, P.B. Berger, V. Bittner, B.J. Gersh, R. Jones, R.M. Califf, H.H. Ting, et al. Outcomes of Patients With Chronic Renal Insufficiency in the Bypass Angioplasty Revascularization Investigation Circulation, May 14, 2002; 105(19): 2253 - 2258. [Abstract] [Full Text] [PDF]

				P. A. McCullough, K. R. Sandberg, and S. Borzak Cardiovascular Outcomes and Renal Disease Ann Intern Med, April 16, 2002; 136(8): 633 - 634. [Full Text] [PDF]

				L. M. Ruilope, D. J. van Veldhuisen, E. Ritz, and T. F. Luscher Renal function: the Cinderella of cardiovascular risk profile J. Am. Coll. Cardiol., December 1, 2001; 38(7): 1782 - 1787. [Abstract] [Full Text] [PDF]