Renal Insufficiency May Be Associated With Impaired Regenerative Capacity in CAD

Renal insufficiency may be linked to reduced circulating progenitor cell (CPC) counts, a factor indicative of impaired regenerative capacity in older adults with coronary artery disease (CAD), according to study results intended to be presented at the annual meeting of the American College of Cardiology (ACC 2020).

Anurag Mehta, MBBS, from the Emory University School of Medicine, Atlanta, Georgia, and colleagues estimated the number of CPCs with flow cytometry. CPCs were CD45^med+ cells with a single nucleus expressing epitopes for CD34 and CD133. The samples of 1281 patients with CAD (mean age, 66 years; 39% women; 21% black) were analyzed. The association between renal insufficiency (ie, estimated glomerular filtration rate <60 mL/min/1.73 m²) and log-transformed CPC counts was examined using adjusted linear regression models. Furthermore, using adjusted Cox models, the investigators assessed the predictive value of CPC counts for cardiovascular death or myocardial infarction during a 3.5-year median follow-up period.

In unadjusted analyses renal insufficiency was
found to be associated with lower counts of CD34⁺ cells (-10.1%; 95%
CI, -16.9% to -2.8%; P =.008) and with
lower counts of CD34⁺/CD133⁺ cells (-11.4%; 95% CI,
-19.4% to -2.6%; P =.13) in 446
patients.

After adjusting for age, renal insufficiency
was independently associated with lower counts of CD34⁺ cells (14.5%;
95% CI, -24.4% to -3.4%; P =.012) and
with lower counts of CD34⁺/CD133⁺ cells (-15.7%; 95% CI,
-28.7% to -0.4%; P =.045) in patients
≥70 years. Patients with renal insufficiency who had counts below the median
for CD34⁺ or CD34⁺/CD133⁺ cells were found to
be at a higher risk for adverse events (adjusted hazard ratio, 1.76; 95% CI,
1.24-2.52 and adjusted hazard ratio, 1.80; 95% CI, 1.26-2.56, respectively).
Notably, patients with renal insufficiency and CPC counts above the median
value had a similar risk for cardiovascular death or myocardial infarction
compared with patients without renal insufficiency.

The investigators concluded, “Impaired
regenerative capacity in patients with CAD and [renal insufficiency] independently
predicts cardiovascular risk.”

Reference

Mehta A, Tahhan AS, Liu C, et al. Impaired regenerative capacity predicts outcomes in patients with coronary artery disease and renal insufficiency. Intended to be presented at: American College of Cardiology 69th Annual Scientific Session; March 28-30, 2020; Chicago, IL. Presentation 915-07. Accessed March 24, 2020.