Painless myocardial ischemia (PMI) is common among patients with chronic kidney disease (CKD) and is associated with an increased mortality risk, according to researchers.

James B. Wetmore, MD, MS, of the University of Kansas School of Medicine in Kansas City, and colleagues studied 356 patients who underwent percutaneous coronary intervention. They defined PMI as an absence of chest pain in response to balloon dilation of the affected vessel.

PMI was present in 20.6% of patients with an estimated glomerular filtration rate (eGFR) of 90 mL/min/1.73 m2 or higher compared with 50% of those with an eGFR below 30, a difference that was statistically significant, the investigators reported online ahead of print in Nephron Clinical Practice.

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Compared with patients with neither CKD nor PMI, those with both CKD and PMI had a significant twofold increased mortality risk; patients with CKD but no PMI had a 64% increased mortality risk

“These findings may partially explain the high mortality traditionally attributed to cardiovascular disease in CKD patients,” the authors concluded.