Therapeutic Management in Patients with Renal Failure who Experience an Acute Coronary Syndrome

Cardinal, Héloïse; Bogaty, Peter; Madore, François; Boyer, L; Joseph, Lawrence; Brophy, James M.

doi:10.2215/cjn.04290609

Cited by 5 publications

(3 citation statements)

References 37 publications

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“…(27) Evidence suggests this treatment disparity has attenuated,(28) so we examined data from the last year of our study (2008) and found that 71% of our patients with eGFR <60ml/min/1.73m 2 initiated statin therapy within the 90days following an MI, compared to 90% of patients with eGFR >90 ml/min/1.73m 2 . Thus, while relative statin treatment effects may not differ by level of renal function, poor outcome rates and treatment rates do differ by level of renal function, suggesting that attention could be usefully focused on increasing treatment rates among patients with pre-dialysis chronic kidney disease.…”

Section: Discussionmentioning

confidence: 92%

Comparative Effectiveness of Statin Therapy in Chronic Kidney Disease and Acute Myocardial Infarction: A Retrospective Cohort Study

Smith

Johnson

Boudreau

et al. 2015

The American Journal of Medicine

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Background Whether there is a kidney function threshold to statin effectiveness in patients with acute myocardial infarction is poorly understood. Our study sought to help fill this gap in clinical knowledge. Methods We undertook a new-user cohort study of the effectiveness of statin therapy by level of estimated glomerular filtration rate (eGFR) in adults who were hospitalized for myocardial infarction (MI) between 2000 and 2008. Data came from the Cardiovascular Research Network. The primary clinical outcomes were one-year all-cause mortality and cardiovascular hospitalizations, with adverse outcomes of myopathy and development of diabetes mellitus. We calculated incidence rates, the number needed to treat (NNT) and used Cox proportional hazards regression with propensity score matching and adjustment to control for confounding, with testing for variation of effect by level of kidney function. Results Compared with statin non-initiators (n=5,583), statin initiators (n=5,597) had a lower propensity score-adjusted risk for death (HR, 0.79; 95% Confidence Interval [CI], 0.71, 0.88) and cardiovascular hospitalizations (HR, 0.90; 95% CI, 0.82, 1.00). We found little evidence of variation in effect by level of eGFR (p=0.86 for death; p=0.77 for cardiovascular hospitalization). Adverse outcomes were similar for statin initiators and statin non-initiators. The NNT to prevent one additional death over 1 year of follow-up ranged from 15 (95% CI 11, 28) for eGFR <30 ml/min/1.73 m2 requiring statin treatment over 2 years to prevent one additional death, to 67 (95% CI 49, 118) for patients with eGFR >90 ml/min/1.73m2. Conclusions Our findings suggest that there is potential for important public health gains by increasing the routine use of statin therapy for patients with lower levels of kidney function.

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Section: Discussionmentioning

confidence: 92%

Comparative Effectiveness of Statin Therapy in Chronic Kidney Disease and Acute Myocardial Infarction: A Retrospective Cohort Study

Smith

Johnson

Boudreau

et al. 2015

The American Journal of Medicine

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“…This latter finding is quite surprising and in contrast with the therapeutic nihilism often reported in CKD patients. [11,12] However, it must be pointed out that despite the greater use of drugs, the therapeutic goals in the I-DEMAND population were, generally speaking, unsatisfactory and especially so in CKD patients. Taking the two renal components into consideration separately, i.e.…”

Section: Prevalence and Clinical Correlates Of Chronic Kidney Diseasementioning

confidence: 99%

Chronic Kidney Disease in the Hypertensive Patient

Leoncini

Viazzi

Rosei

et al. 2011

High Blood Pressure & Cardiovascular Prevention

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The kidney has been recognized as a sensor of cardiovascular risk. However, evaluation of urinary albumin excretion and estimated glomerular filtration rate is still too often overlooked in clinical practice. The I-DEMAND (Italy-Developing Education and awareness on MicroAlbuminuria in patients with hyperteNsive Disease) study was designed to assess the prevalence of microalbuminuria and its clinical correlates among Italian hypertensive patients. A total of 4151 patients from 87 specialized care centres were included in the study. Overall, this study demonstrated that approximately one-half of the enrolled patients had chronic kidney disease, with albuminuria being present in one-quarter of the individuals. The presence of renal abnormalities was more prevalent in patients with concomitant cardiovascular risk factors. This article discusses the main results of the study and its potential implications in clinical practice.

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“…Additionally, adherence to medication recommendations concerning secondary prevention of disease progression has been shown to be poor in patients with CKD. [16][17][18][19][20] Again, data for long-term medication adherence according to recent guideline recommendations are lacking. In this study, we investigated the stage-specific impact of CKD on the outcome of patients with PAD, including a long-term follow-up.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Mortality After Invasive Angiography and Endovascular Revascularization in Patients With PAD Having Chronic Kidney Disease

et al. 2015

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Peripheral arterial disease (PAD) and chronic kidney disease (CKD) are associated with increased mortality rates. We assessed long-term outcomes of patients with PAD and CKD. Patients with PAD undergoing invasive angiography and/or endovascular revascularization between 2005 and 2010 were retrospectively classified into 5 CKD stages. A follow-up was performed and 572 patients were included, 116 patients (20%) had normal renal function, 245 were in CKD stage 2 (43%), 156 in CKD stage 3 (27%), and 55 in CKD stages 4 + 5 (10%). Diabetes mellitus, hypertension, and anemia were more frequent in higher CKD stages (P < .03). During follow-up (mean 1135 days; 95% confidence interval 1159-1259), cumulative mortality was 21% and increased with advanced CKD stages (9%, 16%, 29%, and 47%, respectively, P < .001). In multivariate Cox regression models, higher CKD stages were significantly associated with poor survival. Medication adherence for secondary prevention was significantly lower than recommended but irrespective of CKD stages. Kidney function is an independent predictor of worse long-term survival in patients with PAD. While standard medications were used less often than recommended, no differences between CKD stages were noted.

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Therapeutic Management in Patients with Renal Failure who Experience an Acute Coronary Syndrome

Cited by 5 publications

References 37 publications

Comparative Effectiveness of Statin Therapy in Chronic Kidney Disease and Acute Myocardial Infarction: A Retrospective Cohort Study

Comparative Effectiveness of Statin Therapy in Chronic Kidney Disease and Acute Myocardial Infarction: A Retrospective Cohort Study

Chronic Kidney Disease in the Hypertensive Patient

Long-Term Mortality After Invasive Angiography and Endovascular Revascularization in Patients With PAD Having Chronic Kidney Disease

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