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Early, frequent nephrology care improves cardiovascular outcomes post-dialysis initiation
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Patients who had frequent nephrologist appointments several months before beginning dialysis had reduced risk for adverse cardiovascular events 1 year after initiation, according to a published study.
“Patients with chronic kidney disease have a five- to 10-fold higher risk for cardiovascular (CV) diseases, such as coronary artery disease, stroke and heart failure, than age-matched controls,” Ju-Yeh Yang, MD, MS, of the division of nephrology and the department of quality management center at Far Eastern Memorial Hospital in Taiwan, and colleagues wrote. “Moreover, CV events are the leading cause of death in patients with CKD. Studies have shown that pre-dialysis nephrology care can effectively control CKD-related complications and can reduce mortality in and hospitalization of patients with end-stage renal disease on maintenance dialysis therapy. However, clinical data are limited and do not clearly delineate the association between pre-dialysis nephrology care and CV outcomes.”
Researchers conducted an observational cohort study of 60,329 patients who initiated maintenance dialysis therapy between 1999 and 2010. Nephrology care prior to dialysis was categorized by duration — “early” (appointments beginning 6 months or more before dialysis) or “late” (appointments beginning less than 6 months before dialysis) — as well as by frequency. Frequent care was defined as at least one nephrology visit every 3 months, while infrequent care was less than one visit every 3 months. The occurrence of major adverse cardiovascular events (MACEs), such as acute myocardial infarction, acute heart failure, acute stroke or sudden death, in the first year of dialysis therapy were determined.
Among the cohort, 40.6% of patients had early frequent care, 21.2% had early infrequent care and 38.3% had late care. Researchers observed that, compared with late care, early frequent care was associated with an approximately 10% lower risk for MACEs (both first and recurrent). Patients who had early but infrequent care had similar risks for MACEs as those who had late care.
“Our data revealed a positive association between pre-dialysis nephrology care and post-dialysis 1-year MACEs, except for acute myocardial infarction,” the researchers wrote. “Improved control of anemia, fluid overload and potassium homeostasis could decrease the risk for acute heart failure, stroke and sudden death in a short time frame ... The pre-dialysis period is crucial for preventing MACEs. We suggest clinicians consider early consultation with nephrologists while providing health care to patients with CKD.” – by Melissa J. Webb
Disclosures: The authors report no relevant financial disclosures.
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