Impaired renal function and atherosclerosis in a Pakistani cohort.

OBJECTIVE To investigate the relationship of creatinine and calculated glomerular filtration rate (GFR) with coronary arterial disease (CAD) in Pakistani patients. SUBJECTS Four hundred individuals with chest pain; 200 with angiographic disease matched with 200 without occlusive disease. DESIGN A prospective case-control study. SETTING A tertiary referral cardiology unit in Pakistan. RESULTS Impaired renal function as estimated by calculated GFR was common in this population. Creatinine and glomerular filtration rate, as calculated by the Cockcroft-Gault (CG) and Modification of Diet in Renal Disease (MDRD) formulae, were associated with CAD and atherosclerotic burden in Pakistani patients. Calculation of creatinine clearance, correcting for age, sex and body mass index, showed that clearance was 81 (17-257) mL/min/1.73 m2 in patients with CAD compared with 88 (23-167) mL/min/1.73 m2 in controls with a significant number of patients (18.5 vs. 6.5%; RR = 2.85; p < 0.001) showing significant renal impairment (< 60 mL/min/1.73 m2) by CG and more by the MDRD equation (26 vs. 9%; RR = 2.88; p < 0.001). The unadjusted odds ratios for CAD for a GFR < 60 mL/min/1.73 m2 were 3.66 (1.87-7.16) and 3.29 (1.81-6.01), respectively and, after adjustment for diabetes, smoking, insulin resistance, inflammation and apolipoprotein A1, 1.04 (1.02-1.09) and 1.04 (1.02-1.09), respectively. CONCLUSIONS Impaired renal function is common in Pakistani patients with coronary arterial disease and is strongly associated with a risk of atherosclerosis independent of insulin resistance.