RESEARCH ARTICLE
Estimated Glomerular Filtration Rate and Mortality among Patients with Coronary Heart Disease Qian Chen1,2☯, Yuan Zhang3☯, Ding Ding1, Min Xia1, Dan Li1, Yunou Yang1, Qing Li1, Jiaxing Liu1, Xuechen Chen1, Gang Hu2*, Wenhua Ling1*
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1 Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China, 2 Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA, United States of America, 3 Department of Cardiology, General Hospital of Guangzhou Military Command of People’s Liberation Army, Guangzhou, Guangdong, China ☯ These authors contributed equally to this work. *
[email protected] (WL);
[email protected] (GH)
Abstract OPEN ACCESS Citation: Chen Q, Zhang Y, Ding D, Xia M, Li D, Yang Y, et al. (2016) Estimated Glomerular Filtration Rate and Mortality among Patients with Coronary Heart Disease. PLoS ONE 11(8): e0161599. doi:10.1371/journal.pone.0161599 Editor: Emmanuel A Burdmann, University of Sao Paulo Medical School, BRAZIL Received: May 26, 2016
Objective The association between estimated glomerular filtration rate (eGFR) and the risk of mortality among patients with coronary heart disease (CHD) is complex and still unclear. The aim of this study was to evaluate the effect of eGFR on the risk prediction of all-cause and cardiovascular disease (CVD) mortality with a long follow-up period among patients with CHD in China.
Accepted: August 8, 2016 Published: August 18, 2016 Copyright: © 2016 Chen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: Due to restrictions that protect participant privacy, data are available upon request. The data will be available upon request to all interested researchers. Interested parties may contact the Sun Yat-Sen University Ethics Committee and the GCADC study group (contact information: Wenhua Ling,
[email protected]). Funding: This study was supported and funded by the Key Project of National Natural Science Fund (grant number 81130052). Qian Chen is supported by International Program for Ph.D. Candidates, Sun YatSen University. The funders had no role in study
Methods We conducted a prospective cohort study of 3276 Chinese patients with CHD. Cox proportional hazards regression models were used to estimate the association of different levels of eGFR with the risks of mortality.
Results During a mean follow-up period of 4.9 years, 293 deaths were identified. The multivariableadjusted hazard ratios associated with different levels of eGFR (90 [reference group], 60– 89, 30–59, 15–29 ml/min per 1.73m2) at baseline were 1.00, 1.28 (95% confidence interval [CI], 0.87–1.88), 1.96 (95% CI, 1.31–2.94), and 3.91 (95% CI, 2.15–7.13) (P 0.75
Age groups, y 0.75
>0.10
History of diabetes No
1.00
1.57 (1.15–2.15)
Yes
1.00
2.29 (1.50–3.49)
0.25
Types of coronary artery disease Chronic coronary artery disease
1.00
1.89 (1.26–2.85)
Acute coronary syndrome
1.00
1.61 (1.18–2.19)
>0.05
>0.10
Use of glucose-lowering medications
0.05
Use of antihypertensive medicines
>0.25
No
1.00
1.38 (0.93–2.05)
1.00
1.30 (0.79–2.15)
Yes
1.00
2.07 (1.49–2.88)
1.00
2.13 (1.42–3.20)
Abbreviation: HR, hazard ratio; CI, confidence interval; CVD, cardiovascular disease; and eGFR, estimated glomerular filtration rate. a
Adjusted for age, sex, education, smoking, marriage, alcohol drinking, marriage, leisure-time physical activity, fasting glucose, body mass index, systolic blood pressure, high-density lipoprotein cholesterol, triglycerides, types of coronary artery disease, use of antihypertensive medications, use of glucoselowering medications, use of lipid-lowering medications, and use of antiplatelet medications, other than the variable for stratification. doi:10.1371/journal.pone.0161599.t003
min per 1.73 m2) and the risks of all-cause and CVD mortality among Chinese patients with both ACS and chronic coronary artery disease, and with acute and chronic status combined. This gives a very important message for clinical treatment for CHD patients. In the present study, about 38.6% of deaths occur within the first 2 years of follow-up, it is possible that some biomarkers of severity of the acute CAD events would dominate the explanation of short-term mortality risks. Our study is the first to demonstrate the association between eGFR and mortality within the first 2 years of follow-up especially after excluding Table 4. Impact of eGFR levels and metrics of discrimination. All-cause mortality
Cardiovascular disease mortality
Clinical model a
Clinical model + eGFR
Clinical model a
Clinical model + eGFR
0.761
0.767
0.772
0.778
C Index P
