This Article Free upon publication Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Sarafidis, P. A. Articles by Bakris, G. L. Search for Related Content PubMed PubMed Citation Articles by Sarafidis, P. A. Articles by Bakris, G. L. Pubmed/NCBI databases Medline Plus Health Information Coronary Artery Bypass Surgery Related Collections Risk Factors CV surgery: coronary artery disease Chronic ischemic heart disease

(Circulation. 2006;113:1046-1047.)
© 2006 American Heart Association, Inc.

Editorial

Level of Kidney Function Determines Cardiovascular Fate After Coronary Bypass Graft Surgery

Panteleimon A. Sarafidis, MD; George L. Bakris, MD

From the Hypertension/Clinical Research Center, Department of Preventive Medicine, Rush University Medical Center, Chicago, Ill.

Correspondence to George L. Bakris, MD, Hypertension/Clinical Research Center, Department of Preventive Medicine, Rush University Medical Center, 1700 W Van Buren, Suite 470, Chicago, IL 60612. E-mail gbakris@earthlink.net

Key Words: Editorials • kidney • morbidity • mortality • surgery

An extract of the first 250 words of the full text is provided, because this article has no abstract.

The traditional risk factors for cardiovascular (CV) disease, ie, hypertension, diabetes, or metabolic syndrome, are also risk factors for chronic kidney disease development.¹ For more than a quarter of a century, the association between late-stage kidney disease, ie, glomerular filtration rate (GFR) <30 mL/min, and higher CV death rate has been recognized.² Only recently, however, have studies in the general population^3–5 and in cohorts with previous CV events⁶ linked the continuum of increasing CV risk with decreasing kidney function. This is related in part to the fact that current studies used validated formulas derived from kidney disease outcome trials^7,8 to find an estimated GFR (eGFR) rather than simply measuring serum creatinine randomly.

Articles pp 1056 and 1063

All studies published within the last decade indicate that when GFR falls to <60 mL/min (stage 3 nephropathy), a significant increase in CV events occurs.^5,6 This may relate to the fact that as GFR falls to <60 mL/min, many physiological and regulatory functions of the kidney start to wane; such functions include reductions in 1,25[OH] vitamin D and erythropoietin synthesis. Alterations in these regulatory hormones produce, over time, a vascular environment that promotes increased vascular calcification, reduced oxygen carrying capacity, and thus increased CV risk.¹

Subtle changes in calcium/phosphate homeostasis indicated that initial decreases in 1,25[OH] vitamin D and subsequent increases in parathyroid hormone are detectable when GFR is just <60 mL/min and become obvious when GFR is <45 mL/min. A calcium/phosphate product of >55 also can occur at this GFR level and . . . [Full Text of this Article]

This article has been cited by other articles:

				P. A. Sarafidis and G. L. Bakris Microalbuminuria and chronic kidney disease as risk factors for cardiovascular disease Nephrol. Dial. Transplant., September 1, 2006; 21(9): 2366 - 2374. [Full Text] [PDF]