INTERASPIRE: CKD screening in people with coronary artery disease

Chronic kidney disease (CKD) is an independent risk factor for the development of coronary artery disease (CAD). As CKD is usually asymptomatic and is associated with poorer prognoses in people with CAD, screening for renal involvement is essential. A combination of estimated glomerular filtration rate (eGFR) and urinary albuminuria–creatinine ratio (UACR) is optimal for screening, as studies show that many cases go unrecognised using eGFR alone. 

INTERASPIRE, a longitudinal observational study of adults with CAD, aimed to quantify the prevalence of CKD in people with CAD from 14 countries across all World Health Organization regions and to evaluate the prognostic value of eGFR and UACR. A total of 4548 consecutive patients (21% women), aged 18 to 80 years, hospitalised with a first or recurrent CAD event from 2020–2023, were identified. 

Baseline data, including eGFR and UACR, were collected between 6 and 24 months after the index event. Complete information on kidney function and cardiorenal protective therapy was available for 3865 participants, and follow-up data after a median of 1.02 years were available for 3577 (92.5%).

According to KDIGO classifications, overall prevalence of CKD was 32.3%. Of these, 19.7% were at low–moderate risk, 6.9% were at high risk and 5.6% were at very-high risk. Among 1244 individuals with any degree of CKD, 638 (51.3%) would have been undetected if no UACR had been available. 

The primary event (a composite of the first of cardiovascular death, hospitalisation for non-fatal myocardial infarction, stroke and hospitalisation for heart failure) was experienced by 4.7% of participants, with the highest incidence in the KDIGO high-risk group (men 11.0%; women 9.6%; adjusted HR, 3.46 [95% CI, 2.28–5.25]). This relationship was independent of other risk factors.

The prognostic information regarding the primary endpoint of the combination of UACR and eGFR (HR, 3.72 [2.42–5.72]) was superior to that of eGFR alone (HR, 1.79 [1.19–2.71]) or UACR alone (HR, 2.53 [1.59–4.03]). Only a minority of individuals received adequate cardiorenal protective therapy.

The findings underline the importance of screening for CKD in people with CAD using both UACR and eGFR to identify those at greatest risk and guide the use of cardiorenal protective therapies. These findings were consistent across all countries and favour the inclusion of a recommendation in international CAD management guidelines to screen for CKD using both tests. 

The full article can be read here.