ckd is a major and serious risk factor for coronary artery disease ( cad ) . cad is extremely common in the population of uremic patients . in people with established cad , ckd predicts recurrent events as strongly as other established cardiovascular risk factors such as diabetes and elevated blood pressure . whether the cardiovascular risk in the setting of ckd is due to increased atherosclerotic burden , higher risk of plaque rupture as a result of inflammation , or other mechanisms is unknown . the incidence and severity of obstructive cad increases as glomerular filtration rate ( gfr ) declines . cad shows a pattern of diffuse multivessel involvement with coronary calcification ; small angiographic studies suggest that this incidence exceeds 50% in unselected ckd five - dimension patients . among patients with cad , are inversely and independently associated with kidney function , particularly at estimated gfr < 15 ml / min/1.73 m. standard cardiovascular risk factors are common in ckd , but do not fully explain the high incidence of cardiovascular events or increased mortality rates ; their association with cardiovascular outcomes is attenuated or even reversed at the most advanced ckd stages . acute kidney injury ( aki ) is a common and serious complication in patients with cad , who undergo coronary angiography ( cag ) . although the incidence of aki requiring dialysis is low , the presence of even small changes in kidney function has been associated with adverse short - term outcomes , including target vessel reocclusion , prolonged hospital stay , and in - hospital mortality . our study aims to determine prevalence of ckd in patients with cad demonstrated on cag , to determine how many went on to develop aki ; amongst those who developed aki how many had complete recovery , partial recovery , and no recovery of renal function . totally , 125 patients admitted to lilavati hospital and research centre , mumbai , between september 2007 and october 2009 with acute coronary syndrome with angiographic evidence of > 50% stenosis in one or more coronary vessels were included in the studyall patients were evaluated for the evidence of ckd . serum creatinine , routine urine analysis , and spot urine for protein to creatinine ratio of all patients were measured using the standard technique in the clinical laboratory . for secondary analysis , creatinine clearance ( ml / min/1.73 m of body surface area ) was estimated by the cockroft  gault equation . patients whose creatinine clearance is < 60 ml / min/1.73 m of body surface area for at least 3 months prior to the current admission are diagnosed to have ckd as per k / doqi clinical practice guidelines for ckdaki was defined according to the risk , injury , failure , loss , and end - stage kidney ( rifle ) criteria . we used the change in serum creatinine level to define aki according to rifle criteria . aki was defined as an increase in serum creatinine levels 1.5  baselineserum creatinine levels were measured at the end of 3 months in those patients , who developed aki , to find out how many had complete recovery , partial recovery and no recovery of their renal function . 
  totally , 125 patients admitted to lilavati hospital and research centre , mumbai , between september 2007 and october 2009 with acute coronary syndrome with angiographic evidence of > 50% stenosis in one or more coronary vessels were included in the study all patients were evaluated for the evidence of ckd . serum creatinine , routine urine analysis , and spot urine for protein to creatinine ratio of all patients were measured using the standard technique in the clinical laboratory . for secondary analysis , creatinine clearance ( ml / min/1.73 m of body surface area ) was estimated by the cockroft  gault equation . patients whose creatinine clearance is < 60 ml / min/1.73 m of body surface area for at least 3 months prior to the current admission are diagnosed to have ckd as per k / doqi clinical practice guidelines for ckd aki was defined according to the risk , injury , failure , loss , and end - stage kidney ( rifle ) criteria . we used the change in serum creatinine level to define aki according to rifle criteria . aki was defined as an increase in serum creatinine levels 1.5  baseline serum creatinine levels were measured at the end of 3 months in those patients , who developed aki , to find out how many had complete recovery , partial recovery and no recovery of their renal function . the statistical software namely spss 15.0 was used for the analysis of the data and microsoft word and excel have been used to generate graphs , tables , etc . chi - square / fisher exact test has been used to find the significance of study parameters on the categorical scale between two or more groups . the statistical software namely spss 15.0 was used for the analysis of the data and microsoft word and excel have been used to generate graphs , tables , etc . chi - square / fisher exact test has been used to find the significance of study parameters on the categorical scale between two or more groups . the statistical software namely spss 15.0 was used for the analysis of the data and microsoft word and excel have been used to generate graphs , tables , etc . chi - square / fisher exact test has been used to find the significance of study parameters on the categorical scale between two or more groups . majority of patients ( 40% ) belong to 6070 years age group [ table 1 ] . among 125 patients , 77.6% were found to be males and 22.4% were found to be females [ table 1 ] . hypertension was found to be the more prevalent ( 66.4% ) co - morbid condition associated with cad , followed by diabetes mellitus ( 50.4% ) . left anterior descending was the major vessel involved ( 40% ) , followed by a circumflex artery ( 21.6% ) . majority of the patients had single - vessel disease ( 79.2% ) , followed by triple vessel disease ( 15.2% ) and double vessel disease ( 5.6% ) being the least common . fifty - five percent of patients had < 0.2 g proteinuria / day on spot urine for protein to creatinine ratio estimation , 22.4% had proteinuria in the range of 0.21 g / day , 10.4% between 1 and 2 g / day , 9.6% between 2 and 3 g / day , and 2.4% had proteinuria of > 3 g / day . demographic variables of patients studied approximately 40% of patients had stage iii ckd during admission [ figure 1 ] . approximately 55% of patients who developed aki required renal replacement therapy in the form of hemodialysis ( hd ) . among 55% , significant number of patients requiring hd belongs to ckd group ( 43.8% ) [ figure 2 ] . contrast - induced nephropathy ( cin ) preventive measures in the form of hydration using normal saline or n - acetyl cysteine or sodium bicarbonate were used in 46.9% of ckd patients [ table 3 ] . statistically significant number of patients developed aki in the ckd group , which did not receive any cin preventive measures ( p < 0.001 ) . statistically significant correlation was found between low hemoglobin levels and development of aki in ckd group [ table 4 ] . there was no significant difference with respect to age , gender , body mass index , duration of diabetes and levels of serum creatinine , serum calcium and serum phosphorus levels between patients with and without ckd in development of aki . creatinine clearance at the end of 3 months was measured in those patients who developed aki during their coronary evaluation . majority of patients were found to have a creatinine clearance in the range of 1530 ml / min ( 33.3% ) , followed by 3060 ml / min ( 31.3% ) , > 60 ml / min ( 25% ) and < 15 ml / min ( 10.4% ) . recovery of renal function at the end of 3 months in ckd and non - ckd groups is shown in table 5 . creatinine clearance  at admission aki requiring hemodialysis aki : acute kidney injury , hd : hemodialysis , ckd : chronic kidney disease cin preventive measures and its influence on the development of aki characteristics of patients who developed aki in ckd and non - ckd group it is estimated that up to 11% of adults in the united states have ckd . recent studies have confirmed that even early ckd constitutes a significant risk factor for cardiovascular events and death , and proper management of cvd is different and more complex in patients with ckd . both the frequency of cardiovascular complications and the progression of ckd can be ameliorated in these patients by appropriate intervention . for all these reasons , we evaluated patients who got admitted with cad for the presence of ckd as part of preventive care and treatment strategies . in our study , 78% of the subjects studied were males , 22% of the subjects were females , indicating that cad is more prevalent among males than females . liu et al . in their study found that the prevalence of ckd among the 3513 china heart survey ( chs ) participants with coronary heart disease was 24.8% . mielniczuk et al . in their study , estimated baseline egfr for the 4181 patients with non - st or st elevation acute coronary syndromes who participated in the aggrastat - to - zocor trial . the baseline egfr in their study was 67.8 ml / min/1.73 m ( range , 9.7149.2 ml / min/1.73 m ) indicating that a significant number of patients had underlying ckd . in our study , 48 patients ( 38.4% ) out of 125 developed aki ( defined as an increase in serum creatinine levels 1.5  baseline ) . 54.2% ( 26 out of 48 ) of these aki patients required renal replacement therapy in the form of hd . requirement of hd was more in patients with underlying ckd ( 21 vs. 5 ) as compared to non - ckd patients . performed an observational study of 147,007 elderly medicare patients admitted for acute myocardial infarction ( ami ) as a part of the cooperative cardiovascular project . they evaluated the association between aki and all - cause mortality in the above - mentioned population . in their study , studied the incidence and clinical significance of transient versus persistent aki in 1957 patients who survived an st - elevation ami . aki developed in 46.7% of the patients , of these 3.9% ( 10 ) patients received renal replacement therapy . we followed - up 48 patients , who developed aki to find out how many had complete recovery , partial recovery , and no recovery of aki at the end of 3 months . of 14 non - ckd patients who developed aki , 8 ( 57.1% ) patients had complete recovery and 6 ( 42.9% ) had partial recovery of aki . of 34 ckd patients , 16 ( 47.1% ) had complete recovery , 10 ( 29.4% ) had partial recovery , and 8 ( 23.5% ) had no recovery of aki . statistically significant number of patients developed no recovery of their renal function in ckd group ( 23.5% vs. 0 ) as compared to non - ckd ( p < 0.001 ) . . however , limited time that we get to do our thesis makes it difficult to include large numberslong - term follow - up was not done in our study . long - term follow - up would have given a better idea about progression of renal dysfunction and its impact on cardiovascular and renal morbidity and mortalityfinally , we did not address the influence of different therapies that were administered during the acute phase of the cad on the changes in renal function . . however , limited time that we get to do our thesis makes it difficult to include large numbers long - term follow - up was not done in our study . long - term follow - up would have given a better idea about progression of renal dysfunction and its impact on cardiovascular and renal morbidity and mortality finally , we did not address the influence of different therapies that were administered during the acute phase of the cad on the changes in renal function . in view of high prevalence of ckd ( 39.2% ) in patients with cad , every patient undergoing cag must have renal function evaluation before cag including urine , spot urine for albumin to creatinine ratio and serum creatinine levelsconsidering such a high prevalence of ckd , nephrology referral must be considered in patients with abnormal urinalysis , spot urinary albumin to creatinine ratio , and in patients whose creatinine clearance is < 60 ml / minaki is an important complication of cag and precautions should be taken to prevent itsignificant number of patients has worsening of renal function at the end of 3 months . we find many patients developing progressive ckd after an episode of acute coronary syndromeall patients should have their renal function assessed 3 months after the cag . 
  in view of high prevalence of ckd ( 39.2% ) in patients with cad , every patient undergoing cag must have renal function evaluation before cag including urine , spot urine for albumin to creatinine ratio and serum creatinine levels considering such a high prevalence of ckd , nephrology referral must be considered in patients with abnormal urinalysis , spot urinary albumin to creatinine ratio , and in patients whose creatinine clearance is < 60 ml / min aki is an important complication of cag and precautions should be taken to prevent it significant number of patients has worsening of renal function at the end of 3 months . we find many patients developing progressive ckd after an episode of acute coronary syndrome all patients should have their renal function assessed 3 months after the cag . liu et al . in their study found that the prevalence of ckd among the 3513 china heart survey ( chs ) participants with coronary heart disease was 24.8% . estimated baseline egfr for the 4181 patients with non - st or st elevation acute coronary syndromes who participated in the aggrastat - to - zocor trial . the baseline egfr in their study was 67.8 ml / min/1.73 m ( range , 9.7149.2 ml / min/1.73 m ) indicating that a significant number of patients had underlying ckd . in our study , 48 patients ( 38.4% ) out of 125 developed aki ( defined as an increase in serum creatinine levels 1.5  baseline ) . of 48 patients who developed aki , 54.2% ( 26 out of 48 ) of these aki patients required renal replacement therapy in the form of hd . requirement of hd was more in patients with underlying ckd ( 21 vs. 5 ) as compared to non - ckd patients . performed an observational study of 147,007 elderly medicare patients admitted for acute myocardial infarction ( ami ) as a part of the cooperative cardiovascular project . they evaluated the association between aki and all - cause mortality in the above - mentioned population . in their study , goldberg et al . studied the incidence and clinical significance of transient versus persistent aki in 1957 patients who survived an st - elevation ami . aki developed in 46.7% of the patients , of these 3.9% ( 10 ) patients received renal replacement therapy . we followed - up 48 patients , who developed aki to find out how many had complete recovery , partial recovery , and no recovery of aki at the end of 3 months . of 14 non - ckd patients who developed aki , 8 ( 57.1% ) patients had complete recovery and 6 ( 42.9% ) had partial recovery of aki . of 34 ckd patients , 16 ( 47.1% ) had complete recovery , 10 ( 29.4% ) had partial recovery , and 8 ( 23.5% ) had no recovery of aki . statistically significant number of patients developed no recovery of their renal function in ckd group ( 23.5% vs. 0 ) as compared to non - ckd ( p < 0.001 ) . . however , limited time that we get to do our thesis makes it difficult to include large numberslong - term follow - up was not done in our study . long - term follow - up would have given a better idea about progression of renal dysfunction and its impact on cardiovascular and renal morbidity and mortalityfinally , we did not address the influence of different therapies that were administered during the acute phase of the cad on the changes in renal function . . however , limited time that we get to do our thesis makes it difficult to include large numbers long - term follow - up was not done in our study . long - term follow - up would have given a better idea about progression of renal dysfunction and its impact on cardiovascular and renal morbidity and mortality finally , we did not address the influence of different therapies that were administered during the acute phase of the cad on the changes in renal function . 
 in view of high prevalence of ckd ( 39.2% ) in patients with cad , every patient undergoing cag must have renal function evaluation before cag including urine , spot urine for albumin to creatinine ratio and serum creatinine levelsconsidering such a high prevalence of ckd , nephrology referral must be considered in patients with abnormal urinalysis , spot urinary albumin to creatinine ratio , and in patients whose creatinine clearance is < 60 ml / minaki is an important complication of cag and precautions should be taken to prevent itsignificant number of patients has worsening of renal function at the end of 3 months . we find many patients developing progressive ckd after an episode of acute coronary syndromeall patients should have their renal function assessed 3 months after the cag . in view of high prevalence of ckd ( 39.2% ) in patients with cad , every patient undergoing cag must have renal function evaluation before cag including urine , spot urine for albumin to creatinine ratio and serum creatinine levels considering such a high prevalence of ckd , nephrology referral must be considered in patients with abnormal urinalysis , spot urinary albumin to creatinine ratio , and in patients whose creatinine clearance is < 60 ml / min aki is an important complication of cag and precautions should be taken to prevent it significant number of patients has worsening of renal function at the end of 3 months . we find many patients developing progressive ckd after an episode of acute coronary syndrome all patients should have their renal function assessed 3 months after the cag . in view of high prevalence of ckd ( 39.2% ) in patients with cad , every patient undergoing cag must have renal function evaluation before cag including urine , spot urine for albumin to creatinine ratio and serum creatinine levelsconsidering such a high prevalence of ckd , nephrology referral must be considered in patients with abnormal urinalysis , spot urinary albumin to creatinine ratio , and in patients whose creatinine clearance is < 60 ml / minaki is an important complication of cag and precautions should be taken to prevent itsignificant number of patients has worsening of renal function at the end of 3 months . we find many patients developing progressive ckd after an episode of acute coronary syndromeall patients should have their renal function assessed 3 months after the cag . 
  in view of high prevalence of ckd ( 39.2% ) in patients with cad , every patient undergoing cag must have renal function evaluation before cag including urine , spot urine for albumin to creatinine ratio and serum creatinine levels considering such a high prevalence of ckd , nephrology referral must be considered in patients with abnormal urinalysis , spot urinary albumin to creatinine ratio , and in patients whose creatinine clearance is < 60 ml / min aki is an important complication of cag and precautions should be taken to prevent it significant number of patients has worsening of renal function at the end of 3 months . we find many patients developing progressive ckd after an episode of acute coronary syndrome all patients should have their renal function assessed 3 months after the cag .