Chronic kidney disease (CKD) substantially increases cardiovascular risk, yet its prevalence and prognostic significance in patients with established coronary artery disease (CAD) remain incompletely characterized across global populations. A multinational study published in the Journal of the American College of Cardiology evaluated CKD prevalence, cardiovascular risk, and kidney disease detection strategies in patients with CAD across all World Health Organization regions.

The study included adults with CAD from 14 countries who underwent kidney function assessment 6 to 24 months after CAD diagnosis. Estimated glomerular filtration rate (eGFR) and urinary albumin/creatinine ratio (UACR) were evaluated to classify CKD according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. Complete kidney function and treatment data were available for 3,865 patients, while follow-up outcome data were available for 3,577 patients after a median follow-up of 1 year.

Findings

• The study included 4,548 adults with CAD from 14 countries, with CKD present in 32% according to KDIGO classification.
• Among patients with CKD, 19.7% were classified as low-moderate risk, 6.9% as high risk, and 5.6% as very high risk.
• Without urinary albumin/creatinine ratio (UACR) assessment, 51.3% of CKD cases would have remained undetected.
• The primary composite outcome of cardiovascular death, myocardial infarction, stroke, or hospitalization for heart failure occurred in 7.9% of patients during follow-up.
• Cardiovascular event rates were highest in the KDIGO high-risk category, occurring in 13.0% of men and 11.8% of women, independent of other cardiovascular risk factors.
• Only a minority of patients received adequate cardio-renal protective therapy despite elevated cardiovascular risk.

The findings showed that CKD was common among patients with CAD and frequently remained undetected without UACR testing. Combined assessment using both eGFR and UACR may improve CKD detection and cardiovascular risk stratification in this population, while the low use of cardio-renal protective therapy suggests substantial room for improvement in clinical management.