Impact of estimated glomerular filtration rate on vascular disease extent and adverse cardiovascular events in patients without chronic kidney disease

Background: Estimated glomerular filtration rate (eGFR) predicts major adverse cardiovascular events (MACE) in patients with chronic kidney disease (CKD), though the effect of eGFR on MACE and vascular disease extent among individuals with normal or mildly impaired renal function requires definition. Our aim was to examine the prognostic implications of eGFR and its effect on atherosclerosis burden in individuals without CKD undergoing vascular imaging studies. Methods: The study enrolled 2746 consecutive patients undergoing clinically-driven coronary angiography who had an eGFR > 60 mL/min/1.73 m² and no history of CKD. Same-day carotid duplex results were available for 317 patients. Patients were followed for up to 3 years for the occurrence of all-cause mortality, myocardial infarction, and stroke. Results: After adjustment for potential clinical and biochemical confounders, eGFR was found to be independently associated with coronary artery disease extent in the entire study population and among patients with normal renal function (n= 1170; eGFR > 90 mL/min/1.73 m²): odds ratio (OR)= 1.16 (95% confidence interval [CI], 1.09-1.24) and OR= 1.25 (95% CI, 1.11-1.4) per 10 mL/min decrements in eGFR, respectively. Similarly, eGFR was independently associated with carotid artery stenosis in the entire cohort (OR, 1.86 [95% CI, 1.12-3.1]). By Cox regression analysis, eGFR was an independent predictor of the composite MACE end point (hazard ratio, 1.16 [95% CI, 1.04-1.28]), and all-cause mortality (hazard ratio, 1.38 [95% CI, 1.19-1.60]). Conclusions: eGFR is an independent predictor of atherosclerotic vascular disease extent and MACE rates in patients with normal or mildly impaired renal function.