Aspirin, beta-blocker and angiotensin-converting enzyme inhibitor therapy in patients with end-stage renal disease and an acute myocardial infarction

Patterns of cardioprotective medication prescription in incident hemodialysis patients

“…However, in the ESRD setting, statins have been studied in two randomized controlled studies (4D and AURORA trials) with no benefit being conferred with atorvastatin or rosuvastatin, respectively, in primary prevention of death from cardiac causes, non-fatal MI and stroke [18,19,23]. The absence of benefit of statins was despite enrolling over 4,000 ESRD patients combined with a large number of patients [20,24,25]. For example, Miller et al [20] also found suboptimal cardiovascular disease risk factor management in cardiac and diabetic dialysis patients in their cross-sectional study of another Canadian single tertiary care HD center.…”

Cardiovascular disease in end-stage renal disease: the challenge of assessing and managing cardiac disease in dialysis patients

“…In a direct observational comparison between dialysis and non-dialysis patients, 65 years of age or older, use of aspirin (67 vs. 82.4%), beta-blockers (43.2 vs. 50.8%), and ACE inhibitors (38.5 vs. 60.3%) were significantly lower in patients with ESRD compared with non-ESRD patients during an admission for an acute MI [49]. As expected, 30-day mortality was higher in the dialysis group compared with the non-dialysis group (29.0% vs. 18.3%, P \ 0.001), but the relative benefits on 30-day mortality for these treatments were similar among the groups.…”

“…Observational studies in the dialysis population consistently report low rates of the use of cardio protective drugs [47][48][49][50][51][52]. In the United States Renal Data System (USRDS) Dialysis Morbidity and Mortality Study (DMMS), among 3,374 incident dialysis patients, use of angiotensin-converting enzyme (ACE) inhibitors was 22.2%, beta-blockers 16.7%, aspirin 11.4%, and 3-hydroxy-3-methylglutaryl coenzyme (HMG-CoA) reductase inhibitors (statins) 7.3% in patients without CAD.…”

Cardio-renal syndromes: a systematic approach for consensus definition and classification

“…Potential reasons for this therapeutic failure include concerns about worsening of residual renal function and/or therapy-related toxic effects due to low clearance rates [43][44][45]. However, several studies have shown that when appropriately titrated and monitored, cardiovascular medications used in the general population can be safely administered to those with renal impairment and with similar benefits [42,44,46]. Newer approaches to the treatment of cardiac failure such as cardiac resynchronization therapy (CRT) have not yet been studied in terms of their renal functional effects, although preserved renal function after CRT may predict a more favorable outcome [47].…”

“…Regardless of the cause, WRF in the context of heart failure is associated with increased risk for adverse outcomes. The proportion of individuals with WRF or CKD receiving appropriate risk factor modification and/or interventional strategies is lower than the general population [38][39][40][41][42]. Potential reasons for this therapeutic failure include concerns about worsening of residual renal function and/or therapy-related toxic effects due to low clearance rates [43][44][45].…”