Traditional atherosclerotic symptoms of chest pain, shortness of breath, and difficulty climbing stairs are associated with higher risks for future myocardial infarction in patients with nondialysis-dependent chronic kidney disease (CKD), investigators confirm.

Among 3910 participants in the Chronic Renal Insufficiency Cohort study (mean age 58 years), 476 myocardial infarctions occurred over a median follow-up period of 10.4 years. Myocardial infarction occurred a median 213 days after symptom assessment using the Kidney Disease Quality of Life Instrument (KDQOL-36), completed annually.

The risk for myocardial infarction was a significant 30% and 70% higher for patients who reported mild and moderate to severe bother from chest pain, respectively, compared with no bother, Benjamin Lidgard, MD, of the University of Washington, Seattle, and colleagues reported in the Clinical Journal of the American Society of Nephrology. It was a significant 37% and 33% higher for patients who reported mild and moderate to severe shortness of breath, respectively, versus no shortness of breath.

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Inability to climb stairs is a marker of exercise capacity. The risk for myocardial infarction was a significant 44% and 89% higher for participants reporting mild and severe limitations in climbing stairs, respectively, compared with no limitation, the investigators reported. They adjusted models for kidney function and proteinuria, diabetes, hypertension, heart failure, and atrial fibrillation, smoking, body mass index, sex, age, and use of cardiovascular medications.

“These results highlight the possible importance of routine symptom assessment for early manifestations of atherosclerotic disease in ambulatory patients with CKD,” according to Dr Lidgard’s team. It may also “underscore the need for optimal medical therapy.”


Lidgard B, Zelnick LR, O’Brien KD, Bansal N, et al. Patient-reported symptoms and subsequent risk of myocardial infarction in chronic kidney disease. Clin J Am Soc Nephrol. Published online March 17, 2022. doi:10.2215/CJN.12080921