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26-09-2011 | General practice | Article

Differential drug use helps explain high CVD risk in CKD patients


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MedWire News: Differential use of cardiovascular medications following an incident coronary heart disease event might explain the higher adverse cardiovascular event rate in patients with chronic kidney disease (CKD), research suggests.

Coronary heart disease patients with CKD were less likely to receive an angiotensin-converting enzyme (ACE) inhibitor compared with those without CKD, but were more likely to receive calcium-channel blockers.

"More systematic use of selected cardiovascular medication may help to significantly attenuate this risk," report Nisha Bansal (University of California, San Francisco, USA) and colleagues in the journal BMC Nephrology.

Cardiovascular disease is the leading cause of death in patients with CKD, note the researchers.

They examined data from a large study of coronary heart disease patients with and without CKD in order to determine if the differential use of guideline-recommended therapy might explain the increased risk for cardiovascular morbidity.

Past studies have suggested that CKD patients are undertreated with guideline-recommended cardiovascular medications, including ACE inhibitors.

Using the medication possession ratio (MPR), defined as the number of days exposure to medication divided by the number of days of follow-up from enrollment, post-coronary heart disease use of ACE inhibitors was significantly lower in the 159 study patients with CKD, compared with the 1088 patients without CKD (MPR 0.50 vs 0.58).

On the other hand, calcium-channel blocker use was significantly higher among patients with CKD compared with those without (MPR 0.47 vs 0.38).

There was no difference in the use of statins or beta-blockers according to CKD presence.

The incidence of recurrent cardiovascular events and death was significantly higher in CKD patients compared with non-CKD patients, at 13.9 versus 11.5 events per 100 person-years.

The risk for cardiovascular events and death was highest in those with the lowest estimated glomerular filtration rates (eGFR), but the association was not significant after adjusting for cardiovascular medication use.

The researchers note that blood pressure and lipid levels in CKD patients improved during the follow-up period, a finding that suggests the patients were treated aggressively and drug doses optimized in those who received treatment.

"These results suggest that the excess risk of recurrent cardiovascular events and death in patients with CKD may be explained, in part, by the differential use of cardiovascular medications," write Bansal and colleagues.

They add that the lower use of ACE inhibitors might be due to concerns about drug-related adverse effects, such as hyperkalemia, or a hemodynamically mediated decrease in eGFR.

The increased use of calcium-channel blockers is likely due to the difficulty in controlling blood pressure in CKD patients, they suggest.

By MedWire Reporters

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