Association of Coronary Artery Disease and Pulse Pressure with Progression of Renal Disease

Kwon, Soon Kil; Kim, Sang Hyun; Lee, Jeong Ik; Seo, Jang Won; Chang, Jai Won; Kim, Soon Bae; Park, Jung Sik

Abstract

BACKGROUND
Patients with end-stage renal disease have farther excess rate of coronary artery disease (CAD) than nonuremic population. There is a possibility that atherosclerosis may aggravate renal insufficiency, but it is not certain. Pulse pressure was also significantly increased in patients with chronic renal disease (CRD), and had been implicated in the development of atherosclerosis. The purpose of this study is to identify the association of atherosclerotic CAD and pulse pressure with renal disease progression in patients with mild CRD METHODS: The patients with mild CRD who had been followed up more than 3 years in Asan medical center, Seoul, Korea, were included. We evaluated their CAD via coronary angiography, and followed up their serum creatinine levels and other parameters assumed to be associated with progression of CRD. All clinical and laboratory parameters were analyzed by multivariate logistic method. And we examined the association between pulse pressure and progression of CRD with related factors via multivariate logistic analysis. RESULTS: Total 87 patients (54 were men and 33 were women) were included in this study. 45 patients had coronary heart disease and 42 had not. Comparison of CRD progression between the patients who had CAD (n=45) and those who had not (n=42) showed a significant difference (76% vs 52%, p< 0.05). Mean arterial pressure, pulse pressure, presence of diabetic nephropathy, 24hour urine protein, total cholesterol were the parameters associated with the progression of CRD. Among of them, proteinuria and mean arterial pressure were independent risk factors for renal disease progression. There was a significant association between CAD and pulse pressure. CONCLUSION: Atherosclerotic CAD and increased pulse pressure were associated with renal disease progression in the patients with mild renal insufficiency.