Impact of chronic kidney disease on use of evidence-based therapy in stable coronary artery disease : A prospective analysis of 22,272 patients
Kalra, Paul R. (NHLI Imperial College (Londres, Regne Unit))
Garcia-Moll, Xavier (Institut d'Investigació Biomèdica Sant Pau)
Zamorano, José Luis (Hospital Universitario Ramón y Cajal (Madrid))
Kalra, Philip A. (Salford Royal NHS Foundation Trust (Salford, Regne Unit))
Fox, Kim M. (Royal Brompton Hospital (Londres))
Ford, Ian (University of Glasgow (Regne Unit))
Ferrari, Roberto (Ospedale di Cona (Cona, Itàlia))
Tardif, Jean Claude (Université de Montreal (Canadà))
Tendera, Michal (Medical University of Silesia (Katowice, Polònia))
Greenlaw, Nicola (University of Glasgow (Regne Unit))
Steg, Ph Gabriel (Hôpitaux de Paris)
Universitat Autònoma de Barcelona

Data:	2014
Resum:	Purpose: 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. Methods: 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 m. Results: 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 m) was seen in 22. 1% of the cohort (6. 9% with eGFR<45 mL/min/1. 73 m); 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. Conclusions: 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. © 2014 Kalra et al.
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Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Aged ; Angiotensin-Converting Enzyme Inhibitors ; Cardiovascular Agents ; Coronary Artery Disease ; Evidence-Based Medicine ; Female ; Glomerular Filtration Rate ; Humans ; Male ; Middle Aged ; Platelet Aggregation Inhibitors ; Prospective Studies ; Renal Insufficiency, Chronic ; Treatment Outcome
Publicat a:	PloS one, Vol. 9 Núm. 7 (22 2014) , p. e102335, ISSN 1932-6203

DOI: 10.1371/journal.pone.0102335
PMID: 25051258

10 p, 368.8 KB

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