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Kidney disease linked to lower medication use after heart attack
July 10, 2008Patients with kidney disease-especially end-stage renal disease (ESRD) requiring dialysis-are less likely to receive recommended medications after a heart attack, reports a study in the September 2008 Clinical Journal of the American Society of Nephrology (CJASN).
"This is the first systematic report to investigate whether kidney function is associated with use of and adherence with medications that are recommended for secondary prevention after a heart attack," comments Dr. Wolfgang C. Winkelmayer of Brigham and Women's Hospital in Boston, MA. "We found that use of several medications after a heart attack was lower in patients with chronic kidney disease (CKD) or ESRD. However, 1-year adherence did not differ by kidney function."
The researchers analyzed data on medication use after a heart attack, or myocardial infarction, in approximately 21,500 patients. Seventeen percent of the patients had CKD-loss of kidney function that, in many cases, progresses to ESRD. Another two percent had ESRD-permanent loss of kidney function requiring dialysis or transplantation.
Patients with and without kidney disease were compared for use of medications recommended after myocardial infarction: beta-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs/ARBs), and cholesterol-lowering "statin" drugs. Along with aspirin, these three types of drugs are an important part of strategies to prevent further events after myocardial infarction.
Overall rates of medication use were low: after leaving the hospital, just 27 percent of patients filled a prescription for a statin drug. Forty-four percent started treatment with ACEIs/ARBs and 57 percent with beta-blockers.
After adjustment for other factors, patients with CKD were 22 percent less likely to start beta-blocker treatment, compared to patients without kidney disease. There was no difference in ACEI/ARB or statin use.
For ESRD patients, rates of medication use were even lower: 43 percent lower for ACEIs/ARBs and 17 percent lower for statins. (Patients with ESRD were also less likely to start beta-blocker treatment, although the difference wasn't significant.)
Among patients who filled a first prescription, rates of continued medication use after one year were 64 percent for beta-blockers, 57 percent for statins, and 54 percent for ACEIs/ARBs. For all three types of drugs, adherence rates were similar for patients with and without CKD. Patients with ESRD were less likely to continue beta-blocker treatment.
The results may help in understanding how medications affect the relationship between kidney disease and cardiovascular disease. "Kidney function is a well-established risk factor for cardiovascular events such as heart attacks and is also associated with a worse prognosis after such events," says Dr. Winkelmayer. "One possible explanation is differences in health service delivery-it may be that patients with more advanced kidney function receive less state-of-the art care after a heart attack, including less acute coronary intervention, less acute medical intervention, and less chronic, secondary prevention." The results also show some important differences in medication use after myocardial infarction by patients with kidney disease, particularly ESRD. However, these differences don't appear to explain the higher cardiovascular risk among patients with low kidney function.
Over time, rates of adherence to all three types of medications for myocardial infarction are surprisingly low-for patients with and without kidney disease. Especially as rates of kidney disease continue to rise, new ways of reducing cardiovascular risk among patients with low kidney function should be a top priority, the researchers conclude.
The study was limited by a lack of data on vital and laboratory measurements. This included tests to confirm the presence of kidney disease, which was ascertained from health care claims.
American Society of Nephrology
Patients with and without kidney disease were compared for use of medications recommended after myocardial infarction: beta-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs/ARBs), and cholesterol-lowering "statin" drugs. Along with aspirin, these three types of drugs are an important part of strategies to prevent further events after myocardial infarction.
Overall rates of medication use were low: after leaving the hospital, just 27 percent of patients filled a prescription for a statin drug. Forty-four percent started treatment with ACEIs/ARBs and 57 percent with beta-blockers.
After adjustment for other factors, patients with CKD were 22 percent less likely to start beta-blocker treatment, compared to patients without kidney disease. There was no difference in ACEI/ARB or statin use.
For ESRD patients, rates of medication use were even lower: 43 percent lower for ACEIs/ARBs and 17 percent lower for statins. (Patients with ESRD were also less likely to start beta-blocker treatment, although the difference wasn't significant.)
Among patients who filled a first prescription, rates of continued medication use after one year were 64 percent for beta-blockers, 57 percent for statins, and 54 percent for ACEIs/ARBs. For all three types of drugs, adherence rates were similar for patients with and without CKD. Patients with ESRD were less likely to continue beta-blocker treatment.
The results may help in understanding how medications affect the relationship between kidney disease and cardiovascular disease. "Kidney function is a well-established risk factor for cardiovascular events such as heart attacks and is also associated with a worse prognosis after such events," says Dr. Winkelmayer. "One possible explanation is differences in health service delivery-it may be that patients with more advanced kidney function receive less state-of-the art care after a heart attack, including less acute coronary intervention, less acute medical intervention, and less chronic, secondary prevention." The results also show some important differences in medication use after myocardial infarction by patients with kidney disease, particularly ESRD. However, these differences don't appear to explain the higher cardiovascular risk among patients with low kidney function.
Over time, rates of adherence to all three types of medications for myocardial infarction are surprisingly low-for patients with and without kidney disease. Especially as rates of kidney disease continue to rise, new ways of reducing cardiovascular risk among patients with low kidney function should be a top priority, the researchers conclude.
The study was limited by a lack of data on vital and laboratory measurements. This included tests to confirm the presence of kidney disease, which was ascertained from health care claims.
American Society of Nephrology
Kidney Disease Current Events and Kidney Disease News RSSNew class of molecules may help prevent fatal complication in patients with kidney disease
Researchers at the University of Maryland School of Medicine have made an important discovery about why potassium builds up to dangerous levels in the bloodstream, a relatively common medical problem that affects about eight percent of hospitalized patients.
Reduction in glycotoxins from heat-processing of foods reduces risk of chronic disease
Researchers from Mount Sinai School of Medicine report that cutting back on the consumption of processed and fried foods, which are high in toxins called Advanced Glycation End products (AGEs), can reduce inflammation and actually help restore the body's natural defenses regardless of age or health status.
Help your kidneys: Pass on salt and diet soda
Individuals who consume a diet high in sodium or artificially sweetened drinks are more likely to experience a decline in kidney function, according to two papers being presented at the American Society of Nephrology's annual meeting in San Diego, California.
Can charcoal fight heart disease in kidney patients?
Charcoal may provide a new approach to managing the high rate of heart disease in patients with advanced kidney disease, according to preliminary research being presented at the American Society of Nephrology's 42nd Annual Meeting and Scientific Exposition in San Diego, CA.
Women with chronic kidney disease more likely than men to go undiagnosed
Woman are at particular risk of their primary care physicians delaying diagnosis of chronic kidney disease (CKD), according to a paper being presented at the American Society of Nephrology's 42nd Annual Meeting and Scientific Exposition in San Diego, California.
For dialysis patients, skinny is dangerous
Dialysis patients with low body fat are at increased risk of death-even compared to patients at the highest level of body fat percentage, according to research being presented at the American Society of Nephrology's 42nd Annual Meeting and Scientific Exposition in San Diego.
Protein critical for insulin secretion may be contributor to diabetes
A cellular protein from a family involved in several human diseases is crucial for the proper production and release of insulin, new research has found, suggesting that the protein might play a role in diabetes.
Learning the risks for stroke - and taking action
With this theme in mind, the European Society of Cardiology (ESC) emphasises that most of the risks for stroke are also the major risks for coronary heart disease - and thus the object of the ESC's far-reaching prevention programme.
American Dietetic Association supports IOM recommendations on school meal programs
The American Dietetic Association welcomes a report issued Wednesday, October 21, by the Institute of Medicine encouraging federal school meal programs to adopt standards that increase the nutrition content and limit the calories in meals served to schoolchildren.
Cost Effectiveness of Blood Pressure Device Evaluated
A study conducted by the University of Rochester Medical Center (URMC) demonstrates that, for certain patient populations, an experimental device that lowers blood pressure may be a cost effective treatment. The implantable device, called Rheos, is in advanced stages of testing for individuals with drug resistant hypertension.
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