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Acute decline in renal function, inflammation, and cardiovascular risk after an acute coronary syndrome.

Publication ,  Journal Article
Mielniczuk, LM; Pfeffer, MA; Lewis, EF; Blazing, MA; de Lemos, JA; Mohanavelu, S; Rouleau, J; Fox, K; Pedersen, TR; Califf, RM
Published in: Clin J Am Soc Nephrol
November 2009

BACKGROUND AND OBJECTIVES: Chronic kidney disease is associated with a higher risk of cardiovascular outcomes. The prognostic significance of worsening renal function has also been shown in various cohorts of cardiac disease; however, the predictors of worsening renal function and the contribution of inflammation remains to be established. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Worsening renal function was defined as a 25% or more decrease in estimated GFR (eGFR) over a 1-mo period in patients after a non-ST or ST elevation acute coronary syndromes participating in the Aggrastat-to-Zocor Trial; this occurred in 5% of the 3795 participants. RESULTS: A baseline C-reactive protein (CRP) in the fourth quartile was a significant predictor of developing worsening renal function (odds ratio, 2.48; 95% confidence interval, 1.49, 4.14). After adjusting for baseline CRP and eGFR, worsening renal function remained a strong multivariate predictor for the combined cardiovascular composite of CV death, recurrent myocardial infarction (MI), heart failure or stroke (hazard ratio, 1.6; 95% confidence interval, 1.1, 2.3). CONCLUSIONS: Patients with an early decline in renal function after an acute coronary syndrome are at a significant increased risk for recurrent cardiovascular events. CRP is an independent predictor for subsequent decline in renal function and reinforces the idea that inflammation may be related to the pathophysiology of progressive renal disease.

Duke Scholars

Published In

Clin J Am Soc Nephrol

DOI

EISSN

1555-905X

Publication Date

November 2009

Volume

4

Issue

11

Start / End Page

1811 / 1817

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Treatment Outcome
  • Simvastatin
  • Risk Factors
  • Renal Insufficiency, Chronic
  • Randomized Controlled Trials as Topic
  • Prognosis
  • Predictive Value of Tests
  • Multivariate Analysis
  • Multicenter Studies as Topic
 

Citation

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ICMJE
MLA
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Mielniczuk, L. M., Pfeffer, M. A., Lewis, E. F., Blazing, M. A., de Lemos, J. A., Mohanavelu, S., … Califf, R. M. (2009). Acute decline in renal function, inflammation, and cardiovascular risk after an acute coronary syndrome. Clin J Am Soc Nephrol, 4(11), 1811–1817. https://doi.org/10.2215/CJN.03510509
Mielniczuk, Lisa M., Marc A. Pfeffer, Eldrin F. Lewis, Michael A. Blazing, James A. de Lemos, Satishkumar Mohanavelu, Jean Rouleau, Keith Fox, Terje R. Pedersen, and Robert M. Califf. “Acute decline in renal function, inflammation, and cardiovascular risk after an acute coronary syndrome.Clin J Am Soc Nephrol 4, no. 11 (November 2009): 1811–17. https://doi.org/10.2215/CJN.03510509.
Mielniczuk LM, Pfeffer MA, Lewis EF, Blazing MA, de Lemos JA, Mohanavelu S, et al. Acute decline in renal function, inflammation, and cardiovascular risk after an acute coronary syndrome. Clin J Am Soc Nephrol. 2009 Nov;4(11):1811–7.
Mielniczuk, Lisa M., et al. “Acute decline in renal function, inflammation, and cardiovascular risk after an acute coronary syndrome.Clin J Am Soc Nephrol, vol. 4, no. 11, Nov. 2009, pp. 1811–17. Pubmed, doi:10.2215/CJN.03510509.
Mielniczuk LM, Pfeffer MA, Lewis EF, Blazing MA, de Lemos JA, Mohanavelu S, Rouleau J, Fox K, Pedersen TR, Califf RM. Acute decline in renal function, inflammation, and cardiovascular risk after an acute coronary syndrome. Clin J Am Soc Nephrol. 2009 Nov;4(11):1811–1817.

Published In

Clin J Am Soc Nephrol

DOI

EISSN

1555-905X

Publication Date

November 2009

Volume

4

Issue

11

Start / End Page

1811 / 1817

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Treatment Outcome
  • Simvastatin
  • Risk Factors
  • Renal Insufficiency, Chronic
  • Randomized Controlled Trials as Topic
  • Prognosis
  • Predictive Value of Tests
  • Multivariate Analysis
  • Multicenter Studies as Topic