Original Investigations
Cardiac risk factors and the use of cardioprotective medications in patients with chronic renal insufficiency,☆☆

https://doi.org/10.1053/ajkd.2001.22070Get rights and content

Abstract

Cardiovascular Disease (CVD) is a major cause of morbidity and mortality among patients with chronic renal insufficiency (CRI). β-Adrenergic blockers, acetylsalicylic acid (ASA), angiotensin-converting enzyme (ACE) inhibitors, and 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) all reduce CVD mortality, but little is known about the extent to which these medications are used in patients with CRI. This study, a prospective cross-sectional study of consecutive patients seen by nephrologists in four Canadian centers for follow-up of progressive CRI in 1999, was performed to investigate the prevalence of coronary risk factors and use of cardioprotective medications among patients with CRI. Patients had creatinine clearances of 75 mL/min or less but were not on dialysis therapy. Three hundred four consecutive patients meeting the inclusion criteria were enrolled. Mean age was 60.8 ± 15.7 years, mean creatinine clearance was 30.3 ± 18 mL/min, and the case mix of kidney diseases was similar to that in the Canadian Organ Replacement Registry data. One hundred seventeen of 304 patients (38.5%) had a history of previous CVD, and the prevalence of CVD was greater in patients with more severe CRI. Two hundred forty-three patients (79.9%) had a history of hypertension, 132 patients (43.4%) had hyperlipidemia, 114 patients (37.5%) had diabetes mellitus, and 71 patients (27.3%) were smokers. Thirty-five percent of the patients with CVD had blood pressures greater than 140/90 mm Hg; 103 patients (33.9%) were administered β-blockers; 196 patients (64.5%), ACE inhibitors or angiotensin-receptor blockers; 83 patients (27.3%), ASA; and 56 patients (18.4%), statins. Patients with diabetes were not more likely than those without diabetes to be prescribed cardioprotective medications. CVD is common in the predialysis population, and its prevalence increases with more severe kidney failure. Despite this, the use of cardioprotective medications is relatively low, and many patients had suboptimal blood pressure control. Given the high burden of disease in these patients, β-blockers and ACE inhibitors should be used to control hypertension and/or for cardioprotection, and the increased use of ASA and statins should be considered.

Section snippets

Patient population

This was a prospective, cross-sectional, multicenter study of consecutive adult patients seen in four nephrology outpatient clinics across Canada (Halifax, London, Saskatoon, and Vancouver). The study was purely descriptive, and no therapeutic interventions were proscribed. All patients seen for routine follow-up of CRI during the 4-week study period in 1999 were eligible for enrollment. Only patients with CRI, defined by abnormal serum creatinine levels documented at least twice (>1 month

Results

Three hundred four consecutive eligible patients were enrolled onto the study. Demographic characteristics of study patients are listed in Table 1.

. Demographic Characteristics of Patients at Index Visit

Age (y)60.8 ± 15.7
Sex (% men)61.8
Race (%)
 White87.3
 Asian4.3
 Black2.7
 Aboriginal2.3
Kidney disease (%)
 Glomerulonephritis28.8
 Diabetic nephropathy27.1
 Ischemic renal disease23.4
 Interstitial renal disease11.2
 Polycystic kidney disease5.3
Proteinuria >1 g/24 h (%)65.3
Creatinine clearance (mL/min)30.3 ±

Discussion

CVD was common (38.5%) in this cohort of patients with CRI. This figure is similar to the prevalence of coronary disease in hemodialysis and peritoneal dialysis patients.1 A previous cohort of Canadian patients with CRI and similar levels of residual kidney function, assembled between 1994 and 1997, also found the prevalence of CVD to be approximately 40%.18 Interestingly, the prevalence of CVD in a community-based cohort of patients with milder renal insufficiency (serum creatinine level, 1.5

Acknowledgements

Acknowledgment: The authors thank Anu Jindal for assistance with data entry.

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    Supported in part by Biomedical Research Fellowships from the Kidney Foundation of Canada (M.T. and J.G.) and Baxter Corporation (M.T.).

    ☆☆

    Address reprint requests to Bryce A. Kiberd, MD, Rm 5077, AAC Dickson Bldg, 5820 University Ave, Halifax, Nova Scotia, B3H 1V8, Canada. E-mail: [email protected]

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