Risks associated with renal dysfunction in patients in the coronary care unit
Peter A. McCullough, MD, MPH, FACCa,b,c,d,
Sandeep S. Soman, MDa,b,c,d,
Shalin S. Shah, MDa,b,c,d,
Stephen T. Smith, MD, FACCa,b,c,d,
Keisha R. Marks, BSa,b,c,d,
Jerry Yee, MDa,b,c,d and
Steven Borzak, MD, FACCa,b,c,d
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
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Figure 1 Relative hazard for cumulative death after discharge from a coronary care unit. A history (Hx) of heart failure is the greatest independent hazard among dichotomous variables. The level of renal function risk is the most important independent factor. *p < 0.00001. **p = 0.0001. ***p < 0.03. ACEI = angiotensin-converting enzyme inhibitor use before admission; ASA = aspirin use before admission; BB = beta-blocker use before admission; Dx severity = cardiac intensive care unit admission diagnosis severity rank; Hb = hemoglobin in g/dl.
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Figure 2 Survival analysis of 9,544 consecutive patients admitted to a CCU and stratified by baseline cCrCl in ml/min per 72 kg. Proportional hazards have been adjusted for age, gender, race, admission diagnosis, history of heart failure, previous aspirin, beta-blocker and angiotensin-converting enzyme inhibitor use, diabetes and baseline hemoglobin in g/dl. This demonstrates an early mortality hazard within five years after discharge for individuals with cCrCl  46.2 ml/min per 72 kg but not on dialysis, as compared with those on dialysis (p < 0.05 for comparisons of groups 3 to 5 versus groups 1 and 2).
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