Table 2.

Evidence supporting common pathophysiology between MVD of the heart and kidney

Reference	Design	Objective	Population	N	Key findings
Nelson et al 201934	Cross-sectional	Measure CFR	ESRD on dialysis and non-obstructive CAD	30	CFR was reduced in patients with ESRD
Kashioulis et al 202035	Cross-sectional	Identify abnormalities on echocardiography	Chronic kidney disease	132	Patients with CKD stages 3 and had left ventricular diastolic dysfunction and reduced CFR
Östlund-Papadogeorgos et al 202046	Descriptive	Determine predictors of index of microvascular resistance	Chronic angina and non-obstructive LAD disease	220	Creatinine clearance was independently associated with index of microvascular resistance
Tsiachris et al 201248	Descriptive study	Identify associations between CFR and cardiac and renal abnormalities	Untreated hypertensives with a positive stress test and no significant CAD	37	Never-treated hypertensives with low CFR had larger LV mass index and higher albumin to creatinine ratio compared to those with higher CFR
Mohandas et al 201536	Descriptive study	Assess if eGFR is associated with reduced CFR	Women with signs/symptoms of ischemia referred for coronary angiography	198	eGFR significantly correlated with CFR
Bozbas et al 200837	Cross-sectional study	Evaluate degree of CMD	ESRD on dialysis	86	CFR was impaired in ESRD compared to renal transplants and controls. On multivariate analysis, creatinine, age, and diastolic dysfunction correlated with CFR
Fukushima et al 201238	Cross-sectional	Determine presence of impaired myocardial perfusion	Referred for myocardial perfusion PET scan without known CAD	230	Global MFR is reduced in patients with CKD and no regional perfusion deficits
Fujii et al 200847	Cross-sectional	Identify relationship between ADMA, eGFR and CMD	Hypertensives with normal or mild renal insufficiency	66	Plasma ADMA levels were highest in patients with reduced eGFR and CFVR eGFR and CFVR were significantly associated with each other
Ragosta et al 200449	Cross-sectional	Determine prevalence of impaired CVR in diabetics with nephropathy and angiographically normal coronary arteries	Diabetics with nephropathy but no CAD	64	Abnormal CVR was associated with patients who had diabetes and nephropathy but not in controls
Akin et al 201444	Cross-sectional	Assess association between eGFR and coronary blood flow	Slow coronary blood flow without obstructive CAD and normal to mildly impaired renal function	430	eGFR was significantly correlated with SCF in patients with normal to mildly impaired renal function
Chade et al 200639	Descriptive	Determine association between CKD and CMD	Patients referred for angiography where CAD was excluded	605	GFR was significantly associated with CFR Patients with impaired GFR were more likely to be older, hypertensive, and female
Sakamoto et al 201240	Descriptive	Assess if impaired CFR is associated with CKD and cardio-cerebrovascular events	Patients with suspected CAD but no epicardial artery stenosis	73	Patients with CKD had a significantly lower CFR compared to those without CKD. In patients with low CFR, cardio-cerebrovascular events were more common compared to patients with normal CFR
Tsuda et al 201841	Cross-sectional	Measure myocardial perfusion reserve	Chronic kidney disease	92	Patients with CKD had a significantly lower myocardial perfusion reserve compared to those without CKD
Bezante et al 200942	Descriptive	Characterize changes in CFR and early renal disease	Hypertensives	26	Those with impaired CFR also had significantly lower eGFR
Imamura et al 201443	Descriptive	Assess relationship between albuminuria and CMD	Chronic kidney disease	175	Worsening renal function was associated with lower CFVR. Albuminuria was the most powerful predictor of abnormal CFVR
Yilmaz et al 200945	Cross-sectional	Determine the presence of slow coronary flow in patients with impaired renal function	Patients with angiographically normal coronary arteries and a GFR < 90 mL/min/1.73 m2	207	Those with impaired renal function had slower coronary flow (assessed by TIMI flow) compared to those with normal renal function
Jalnapurkar et al 202150	Descriptive	Evaluate relationship between UACR and invasive coronary function testing	Women with INOCA enrolled in WISE-CVD	152	Coronary endothelial-dependent variables had significant inverse correlations with log UACR

ADMA, asymmetric dimethylarginine; CAD, coronary artery disease; CFR, coronary flow reserve; CMD, coronary microvascular dysfunction; CVR, coronary flow velocity reserve; eGFR, estimated glomerular filtration rate; ESRD, end-stage renal disease; INOCA, ischemia with no obstructive coronary artery disease; LV, left ventricular; MFR, myocardial flow reserve; MVD, microvascular dysfunction; UACR, urine albumin-creatinine ratio; WISE-CVD, Women’s Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction.