Association of Preventive Health Care with Atherosclerotic Heart Disease and Mortality in CKD

Abstract

Chronic kidney disease (CKD, stages 1 to 4) affects approximately 13.1% of United States adults and leads to ESRD, cardiovascular disease, and premature death. Here, we assessed adherence to a subset of Kidney Disease Outcomes Quality Initiative preventive health care guidelines and identified associations between adherence and incident atherosclerotic heart disease (ASHD). Using the Medicare 5% data set, 1999 to 2005 (about 1.2 million patients per year), we created 3-yr rolling cohorts. We classified CKD and diabetes during year 1, assessed preventive care during year 2, and evaluated ASHD outcomes during year 3. We defined preventive care by the receipt of laboratory measurements (serum creatinine, lipids, calcium and phosphorus, parathyroid hormone, and, for patients with diabetes, hemoglobin A1c), influenza vaccination, and by at least one outpatient visit to a nephrologist. Among patients with CKD, 80% received Ն2 serum creatinine tests during the year, and only 11% received parathyroid hormone testing. Cumulative incidence of the combined ASHD outcome was 25% and 11% for patients with and without prevalent cardiovascular disease, respectively. Except for serum creatinine testing, preventive care associated with lower ASHD rates in the subsequent year, ranging from 10% lower for those who received influenza vaccinations and Ն2 A1c tests, to 43% lower for calcium-phosphorus assessment. Receiving Ն2 serum creatinine tests associated with a 13% higher rate of ASHD. A higher number of preventive measures associated with lower rates of ASHD. In summary, these data support an association between preventive measures and reduced cardiovascular morbidity and mortality.

Outcomes Associated with Influenza Vaccination in the First Year after Kidney Transplantation

“…Two smaller studies from Poland and Greece showed similar results (9,10). The lower risk of death is consistent with other influenza vaccine studies in the chronic kidney disease and ESRD populations (11,12).…”

“…Despite recommendations from society guidelines, only 19% of patients had claims for influenza vaccination within the first year after transplant in this cohort. This rate is lower than reported in the aforementioned chronic kidney disease and ESRD populations using similar methodology (11,12). Multiple surveys and observational studies have previously commented on the low rate of vaccination in solid-organ-transplant recipients internationally (13).…”

Cost-Effectiveness of Adjuvanted Versus Nonadjuvanted Influenza Vaccine in Adult Hemodialysis Patients

“…We limited our analysis to a single year and did not include certain potential longer-term benefits of influenza vaccination such as lowered heart disease risk that has been described in previous studies. 48 Our model tried to represent the average HD patient. While sensitivity analyses explored the effects of some variation, they cannot capture the full possible extent of variability.…”

Web Surveillance for CKD

“…The presence of CKD also associates with various complications and their costs, including cognitive impairment, 14,15 cardiovascular disease, [16][17][18][19] sudden death, 20 abnormal mineral metabolism, [21][22][23] bone fracture, 24 vascular ossification 25 and remodeling, 26 postoperative mortality, 27 risk of AKI, 28,29 cancer, 30 and patient safety 31 just to mention a few. No one is sure all these risks are shared equally across the spectrum of patients with varying degrees of CKD.…”

“…Early efforts to map complications with albuminuria or levels of estimated GFR suggest differential associations. 32 There also are issues with prevention, 16 pre-ESRD access, socioeconomics, and race that affect quality of care, [33][34][35] and save for piecemeal, we cannot interrogate these concerns thoughtfully without establishing a larger pool of valid patients for longitudinal surveillance.…”