Journal Article

Impact of Chronic Kidney Disease on Use of Evidence-Based Therapy in Stable Coronary Artery Disease: A Prospective Analysis of 22,272 Patients

Fox, Kim M., García-Moll, Xavier, Greenlaw, Nicola, Kalra, Philip A., Tardif, Jean-Claude, Zamorano, José, Ford, Ian, Tendera, Michal, Kalra, Paul R., Ferrari, Roberto

2014

Overview

To assess the frequency of chronic kidney disease (CKD), define the associated demographics, and evaluate its association with use of evidence-based drug therapy in a contemporary global study of patients with stable coronary artery disease. 22,272 patients from the ProspeCtive observational LongitudinAl RegIstry oF patients with stable coronary arterY disease (CLARIFY) were included. Baseline estimated glomerular filtration rate (eGFR) was calculated (CKD-Epidemiology Collaboration formula) and patients categorised according to CKD stage: >89, 60-89, 45-59 and <45 mL/min/1.73 m2. Mean (SD) age was 63.9±10.4 years, 77.3% were male, 61.8% had a history of myocardial infarction, 71.9% hypertension, 30.4% diabetes and 75.4% dyslipidaemia. Chronic kidney disease (eGFR<60 mL/min/1.73 m2) was seen in 22.1% of the cohort (6.9% with eGFR<45 mL/min/1.73 m2); lower eGFR was associated with increasing age, female sex, cardiovascular risk factors, overt vascular disease, other comorbidities and higher systolic but lower diastolic blood pressure. High use of secondary prevention was seen across all CKD stages (overall 93.4% lipid-lowering drugs, 95.3% antiplatelets, 75.9% beta-blockers). The proportion of patients taking statins was lower in patients with CKD. Antiplatelet use was significantly lower in patients with CKD whereas oral anticoagulant use was higher. Angiotensin-converting enzyme inhibitor use was lower (52.0% overall) and inversely related to declining eGFR, whereas angiotensin-receptor blockers were more frequently prescribed in patients with reduced eGFR. Chronic kidney disease is common in patients with stable coronary artery disease and is associated with comorbidities. Whilst use of individual evidence-based medications for secondary prevention was high across all CKD categories, there remains an opportunity to improve the proportion who take all three classes of preventive therapies. Angiotensin-converting enzyme inhibitors were used less frequently in lower eGRF categories. Surprisingly the reverse was seen for angiotensin-receptor blockers. Further evaluation is required to fully understand these associations. The CLARIFY (ProspeCtive observational LongitudinAl RegIstry oF patients with stable coronary arterY disease) Registry is registered in the ISRCTN registry of clinical trials with the number ISRCTN43070564. http://www.controlled-trials.com/ISRCTN43070564.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Aged / Angiotensin-converting enzyme inhibitors / Angiotensin-Converting Enzyme Inhibitors - therapeutic use / Angiotensins / Anticholesteremic agents / Beta blockers / Blood pressure / Cardiac arrhythmia / Cardiac patients / Cardiovascular Agents - therapeutic use / Cardiovascular disease / Cardiovascular diseases / Care and treatment / Chronic kidney failure / Clinical medicine / Clinical trials / Comorbidity / Coronary artery / Coronary artery disease / Coronary Artery Disease - drug therapy / Coronary vessels / Demographics / Demography / Diabetes / Diabetes mellitus / Disease prevention / Dyslipidemia / Embolisms / Enzyme inhibitors / Enzymes / Epidemiology / Epidermal growth factor receptors / Evidence-Based Medicine / Female / Glomerular Filtration Rate / Health risk assessment / Health risks / Heart attack / Heart attacks / Heart diseases / Heart failure / Heart rate / Hospitals / Humans / Hypertension / Kidney diseases / Kidneys / Male / Medical research / Medicine and Health Sciences / Middle Aged / Mortality / Myocardial infarction / Patients / Peptidyl-dipeptidase A / Platelet Aggregation Inhibitors - therapeutic use / Prevention / Prospective Studies / Renal Insufficiency, Chronic - physiopathology / Risk analysis / Risk factors / Statins / Therapy / Treatment Outcome / Vascular diseases