Potential role of differential medication use in explaining excess risk of cardiovascular events and death associated with chronic kidney disease: A cohort study

BMC Nephrology

Research Article

Stephen P Fortmann¹  Mark A Hlatky¹  Nisha Bansal²  Chi-yuan Hsu²  Alan S Go³  Carlos Iribarren⁴  Malini Chandra⁴ 

[1] Department of Medicine, Stanford University, Palo Alto, CA, USA;Department of Medicine, University of California, San Francisco, San Francisco, CA, USA;Department of Medicine, University of California, San Francisco, San Francisco, CA, USA;Division of Research, Kaiser Permanente of Northern California, Oakland, CA, USA;Division of Research, Kaiser Permanente of Northern California, Oakland, CA, USA;

关键词: Chronic Kidney Disease;    Acute Myocardial Infarction;    Angiotensin Converting Enzyme Inhibitor;    Chronic Kidney Disease Patient;    Medication Possession Ratio;   

DOI  :  10.1186/1471-2369-12-44

 received in 2011-03-03, accepted in 2011-09-14,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundPatients with chronic kidney disease (CKD) are less likely to receive cardiovascular medications. It is unclear whether differential cardiovascular drug use explains, in part, the excess risk of cardiovascular events and death in patients with CKD and coronary heart disease (CHD).MethodsThe ADVANCE Study enrolled patients with new onset CHD (2001-2003) who did (N = 159) or did not have (N = 1088) CKD at entry. The MDRD equation was used to estimate glomerular filtration rate (eGFR) using calibrated serum creatinine measurements. Patient characteristics, medication use, cardiovascular events and death were ascertained from self-report and health plan electronic databases through December 2008.ResultsPost-CHD event ACE inhibitor use was lower (medication possession ratio 0.50 vs. 0.58, P = 0.03) and calcium channel blocker use higher (0.47 vs. 0.38, P = 0.06) in CKD vs. non-CKD patients, respectively. Incidence of cardiovascular events and death was higher in CKD vs. non-CKD patients (13.9 vs. 11.5 per 100 person-years, P < 0.001, respectively). After adjustment for patient characteristics, the rate of cardiovascular events and death was increased for eGFR 45-59 ml/min/1.73 m2 (hazard ratio [HR] 1.47, 95% CI: 1.10 to 2.02) and eGFR < 45 ml/min/1.73 m2 (HR 1.58, 95% CI: 1.00 to 2.50). After further adjustment for statins, β-blocker, calcium channel blocker, ACE inhibitor/ARB use, the association was no longer significant for eGFR 45-59 ml/min/1.73 m2 (HR 0.82, 95% CI: 0.25 to 2.66) or for eGFR < 45 ml/min/1.73 m2 (HR 1.19, 95% CI: 0.25 to 5.58).ConclusionsIn adults with CHD, differential use of cardiovascular medications may contribute to the higher risk of cardiovascular events and death in patients with CKD.

【 授权许可】

CC BY   
© Bansal et al; licensee BioMed Central Ltd. 2011