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Baseline risk of CKD patients influences the effectiveness of cardiovascular therapies
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The success of cardiovascular therapies, whether medical or surgical, can be influenced by a CKD patient’s level of risk at baseline for cardiovascular disease, researchers concluded in a recent study.
“Outcomes associated with cardiovascular therapies among patients with CKD differed by baseline cardiovascular risk,” David M. Charytan, MD, of the department of medicine, Brigham & Women’s Hospital, and colleagues wrote.
Prior studies that compared the success of medical therapy vs. percutaneous coronary intervention (PCI) or surgical intervention, such as coronary artery bypass grafting (CABG) in CKD patients with cardiovascular disease “have not adequately considered medication optimization or baseline cardiovascular risk and have infrequently evaluated progression to kidney failure,” the investigators wrote. “We compared, separately, the risks for kidney failure and death after treatment with PCI, CABG, or optimized medical therapy for coronary disease among patients with CKD stratified by cardiovascular disease risk.”
The retrospective cohort study included 34,385 individuals with CKD identified from a national sample who underwent angiography or diagnostic stress testing without (low risk) or with (medium risk) prior cardiovascular disease or who presented with acute coronary syndrome (high risk).
Researchers evaluated outcomes based on death or progression to kidney failure in the study group.
In the low-risk patients, 960 underwent PCI, 391 underwent CABG, and 6,426 received medical therapy alone. Among medium-risk patients, 1,812 underwent PCI, 512 underwent CABG, and 9,984 received medical therapy alone. Among high-risk patients, 4,608 underwent PCI, 1,330 underwent CABG, and 8,362 received medical therapy alone.
The results showed that, among low- and medium-risk patients, neither CABG or PCI were associated with reduced mortality compared with medical therapy, but in low-risk patients, CABG was associated with a higher rate of either death or kidney failure. “Coronary revascularization was not associated with improved survival in low-risk patients but was associated with improved survival in high-risk patients despite a greater observed rate of kidney failure,” the researchers wrote.
“These findings may inform clinical decision making in the care of patients with both CKD and cardiovascular disease.” – by Mark E. Neumann
Disclosure: The study was funded by the National Institutes of Health (grant number HL118314-01). Charytan reports consulting income from Amgen and fees from Astra Zeneca and Janssen. The other authors have no relevant financial disclosures.
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