Risks associated with renal dysfunction in patients in the coronary care unit

McCullough, Peter A.; Soman, Sandeep; Shah, Shital; Smith, Stephen T.; Marks, Keisha R.; Yee, Jerry; Borzak, Steven

doi:10.1016/s0735-1097(00)00774-9

Cited by 216 publications

(118 citation statements)

References 17 publications

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“…Most importantly, abnormal RF is an independent predictor of adverse outcome. Recent observations in a coronary care unit population 6,20 and from the Heart Outcomes Prevention Evaluation study (HOPE) 21 have highlighted the increased risk of adverse outcomes in patients with chronic kidney disease not yet receiving renal replacement therapy. However, most studies of renal insufficiency and coronary artery disease have focused on patients on long-term dialysis.…”

Section: Discussionmentioning

confidence: 99%

“…42,43 Finally, left ventricular hypertrophy is highly prevalent in patients starting renal replacement therapy. 6 Treatment strategies directed at these risk factors might reduce this risk.…”

Section: Discussionmentioning

confidence: 99%

“…5 There are few studies of patients with mild to moderate abnormalities of renal function (RF) who have coronary artery disease, although this population is quite large. 6,7 The third National Health And Nutrition Examination Survey (NHANES) 6 found creatinine levels Ն1.5 mg/dL (132.6 mol/L) in 9.74% of men and 1.78% of women. McCullough et al 8 reported a graded association of renal function with mortality in Ϸ9500 patients admitted to a coronary care unit.…”

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confidence: 99%

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Prognostic Implications of Abnormalities in Renal Function in Patients With Acute Coronary Syndromes

et al. 2002

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Background— Outcomes in patients with mild to moderate renal function (RF) abnormalities presenting with acute coronary syndromes (ACS) are not well defined. Methods and Results— A convenience sample of 4 ACS trial databases including all enrolled patients was assessed to determine 30- and 180-day outcomes. The 4 trials were Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) IIb, GUSTO-III, Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT), and Platelet IIb/IIIa Antagonism for the Reduction of Acute coronary syndrome events in a Global Organization Network (PARAGON-A). Patients were stratified into ST-segment elevation (STE) and non–ST-segment elevation (NSE) groups and by the presence or absence of abnormal RF (creatinine clearance <70 mL/min). In the STE group, 7670 of 18 621 patients (41%) had abnormal RF. In the NSE group, 8152 of 19 304 (42%) had abnormal RF. Patients with abnormal RF were older, more often female, and more likely to have adverse baseline characteristics. They had higher mortality and higher mortality/nonfatal myocardial infarction (MI) at both 30 and 180 days, regardless of ST-segment status. Creatinine clearance was independently associated with risk of mortality (hazard ratio 0.79 in the STE group and 0.81 in the NSE group) and with risk of mortality/MI (hazard ratio 0.93) in the NSE group at 180 days. Conclusions— Patients presenting with ACS frequently have abnormal RF. Abnormal RF is a marker of adverse baseline clinical characteristics and is independently associated with increased risk of death and death/MI.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Prognostic Implications of Abnormalities in Renal Function in Patients With Acute Coronary Syndromes

et al. 2002

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“…In addition, we had no important medical comorbidity data, such as chronic renal disease, which has been shown to influence short-and longterm survival. 35 We believe, however, that our findings can be helpful in understanding aspects of CHF populations and patterns of management, but cannot be generalized to the individual and his or her physician's treatment plan.…”

Section: Discussionmentioning

confidence: 86%

Opportunities for improvement in the diagnosis and treatment of heart failure

McCullough

Philbin

Spertus

et al. 2003

Clinical Cardiology

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SummaryBackground: Improved treatment of congestive heart failure (CHF) can slow disease progression, promote clinical stability, and prolong survival.Hypothesis: Patterns in diagnostic test utilization and pharmacotherapy among patients with newly diagnosed heart failure may affect outcomes.Methods: Claims data were analyzed from all diagnostic procedures and prescriptions from 1995 to 1998 in 3,353 patients with heart failure diagnosed within 1 year. Rates of diagnostic testing and categories of drugs prescribed were the main outcome measures. Demographic variables and type of provider were analyzed within a setting whose access to care was controlled.Results: Rates of diagnostic testing with respect to basic, metabolic/endocrine, alternative diagnoses, underlying ischemia, and left ventricular function varied as a function of gender, age, race, and primary versus specialty care provider. Only 4.7% of patients underwent all diagnostics and treatments recommended in current guidelines. However, those patients (27.5%) who underwent an evaluation for ischemic heart disease and were prescribed vasodilators or beta blockers enjoyed the lowest crude mortality.

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“…34 Angiotensin II interacts with other peptides, such as endothelin, transforming growth factor ␤, and platelet-derived growth factor, each of which is implicated in end-organ damage, ventricular hypertrophy, and vascular hypertrophy. 13,33,35 Renal dysfunction, mild or severe, is also associated with increased rates of cardiovascular events 36 -39 and increased cardiovascular mortality, 40,41 and this is particularly true for patients with RAS. 42,43 Thus, there may exist a pathogenic pathway wherein renal ischemia leads to neuroendocrine activation, hypertension, and renal insufficiency.…”

Section: Cardiovascular Disease and Rasmentioning

confidence: 99%

Controversial Treatment of Atherosclerotic Renal Vascular Disease

Dworkin

2006

Hypertension

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A therosclerotic renal artery stenosis (RAS) is a relatively common problem, affecting from 1% to 5% of patients with hypertension. 1,2 Given the high prevalence of hypertension, it follows that there are from 2 million to 4 million individuals with RAS in the United States alone. Autopsy data demonstrate that the incidence of RAS increases with age affecting 18% of individuals between the ages 65 to 74 years and Ͼ40% of those more than age 75. 3 RAS is also common in individuals with vascular disease in other beds and is present in Յ40% of those with overt coronary artery disease, aortoiliac disease, or peripheral vascular disease. 4 -6 At present, the best treatment for RAS is unknown, and, in particular, whether or not revascularization, typically accomplished by angioplasty and stenting, improves clinical outcomes for patients with RAS is unclear. Nevertheless, it is estimated that Ϸ40 000 renal artery angioplasties procedures are performed in the United States each year, which, depending on whether or not the procedure is beneficial, is either far too many or far too few. The purpose of this article is to review current knowledge about atherosclerotic RAS and to discuss the Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) trial, which is examining the best treatment for this disease.

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Risks associated with renal dysfunction in patients in the coronary care unit

Abstract: Baseline renal function is a powerful predictor of short- and long-term events in the CCU population. There is an early hazard for in-hospital and postdischarge mortality for those with a corrected creatinine clearance <46.2 ml/min per kg, but not on dialysis.

Cited by 216 publications

References 17 publications

Prognostic Implications of Abnormalities in Renal Function in Patients With Acute Coronary Syndromes

Prognostic Implications of Abnormalities in Renal Function in Patients With Acute Coronary Syndromes

Opportunities for improvement in the diagnosis and treatment of heart failure

Controversial Treatment of Atherosclerotic Renal Vascular Disease

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