The impact of age and chronic kidney disease on secondary prevention post-primary percutaneous coronary intervention

Zachariah, Donah; Brown, R.; Kanagala, Prathap; Bashir, Aisha; Mohan, Mohapradeep; Callan, Paul; Rajendra, R; Clark, Andrew L.; Squire, Iain B.; Gunning, Margaret; Lang, Chim C.; Kalra, Paul R.

doi:10.1093/qjmed/hct222

Cited by 7 publications

(7 citation statements)

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“…These findings were independent of a number of clinical variables that might impact on use of these drugs, including history of hypertension, diabetes and age. A similar trend of higher use of ARBs following PCI for ST-elevation MI was seen in patients with severe CKD in a recently published UK study [14]. Guidelines relating to the management of patients with CKD do not differentiate between the use of ACE inhibitors or ARBs [20].…”

Section: Discussionmentioning

confidence: 71%

“…The latter figure is perhaps more relevant, since the mean age of subjects in our study was 64 years. A recent study of consecutive patients receiving primary PCI for myocardial infarction in the UK demonstrated a mean age of approximately 64 years, with 17.6% exhibiting CKD stages 3–5 [14]. In the Canadian study [13], the prevalence of comorbidities such as hypertension and diabetes mellitus was greater in those with CKD, but no real difference in lipid profile (excepting triglycerides) was seen.…”

Section: Discussionmentioning

confidence: 94%

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Impact of Chronic Kidney Disease on Use of Evidence-Based Therapy in Stable Coronary Artery Disease: A Prospective Analysis of 22,272 Patients

et al. 2014

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PurposeTo assess the frequency of chronic kidney disease (CKD), define the associated demographics, and evaluate its association with use of evidence-based drug therapy in a contemporary global study of patients with stable coronary artery disease.Methods22,272 patients from the ProspeCtive observational LongitudinAl RegIstry oF patients with stable coronary arterY disease (CLARIFY) were included. Baseline estimated glomerular filtration rate (eGFR) was calculated (CKD-Epidemiology Collaboration formula) and patients categorised according to CKD stage: >89, 60–89, 45–59 and <45 mL/min/1.73 m2.ResultsMean (SD) age was 63.9±10.4 years, 77.3% were male, 61.8% had a history of myocardial infarction, 71.9% hypertension, 30.4% diabetes and 75.4% dyslipidaemia. Chronic kidney disease (eGFR<60 mL/min/1.73 m2) was seen in 22.1% of the cohort (6.9% with eGFR<45 mL/min/1.73 m2); lower eGFR was associated with increasing age, female sex, cardiovascular risk factors, overt vascular disease, other comorbidities and higher systolic but lower diastolic blood pressure. High use of secondary prevention was seen across all CKD stages (overall 93.4% lipid-lowering drugs, 95.3% antiplatelets, 75.9% beta-blockers). The proportion of patients taking statins was lower in patients with CKD. Antiplatelet use was significantly lower in patients with CKD whereas oral anticoagulant use was higher. Angiotensin-converting enzyme inhibitor use was lower (52.0% overall) and inversely related to declining eGFR, whereas angiotensin-receptor blockers were more frequently prescribed in patients with reduced eGFR.ConclusionsChronic kidney disease is common in patients with stable coronary artery disease and is associated with comorbidities. Whilst use of individual evidence-based medications for secondary prevention was high across all CKD categories, there remains an opportunity to improve the proportion who take all three classes of preventive therapies. Angiotensin-converting enzyme inhibitors were used less frequently in lower eGRF categories. Surprisingly the reverse was seen for angiotensin-receptor blockers. Further evaluation is required to fully understand these associations. The CLARIFY (ProspeCtive observational LongitudinAl RegIstry oF patients with stable coronary arterY disease) Registry is registered in the ISRCTN registry of clinical trials with the number ISRCTN43070564. http://www.controlled-trials.com/ISRCTN43070564.

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 94%

Impact of Chronic Kidney Disease on Use of Evidence-Based Therapy in Stable Coronary Artery Disease: A Prospective Analysis of 22,272 Patients

et al. 2014

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“…In our study, although the age group > 65 years had the highest accumulation of cardiovascular co-morbidities, only half of them were prescribed RAS inhibitor. This is perhaps due to the adverse events associated with these medications and the suboptimal use of secondary preventive measures in this age group described in literature [ 21 – 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…This inverse relationship between ESKD and death is consistent with previous studies [ 8 , 25 – 28 ]. For example, O’Hare et al in a study of 209,622 patients aged 18–100 years with CKD stages 3 to 5, showed this inverse relationship between death and ESKD [ 24 ]. In this study the adjusted HR (95% CI) for death in the age group 75–84 years, for CKD stages 3b, 4 and 5 was 2.6 (1.8–3.7), 3.1 (1.9–5.1) and 4.4 (1.6–22.7) respectively, compared to the reference group, of patients aged 18 to 44 years.…”

Section: Discussionmentioning

confidence: 99%

Comparing the impact of older age on outcome in chronic kidney disease of different etiologies: a prospective cohort study

et al. 2018

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BackgroundIn older patients with chronic kidney disease (CKD), the risk of progression to end stage renal disease and cardiovascular death both differ compared to younger patients. This likely reflects differences in case mix and co-morbid burdens. We sought to establish the extent to which age itself is an independent biomarker of adverse outcome in CKD.MethodsThis was an analysis of the Salford Kidney Study, a prospective, longitudinal, observational study of 2,667 patients with eGFR < 60 ml/min/1.73 m2. Patients were divided into four age groups (< 55, 55–65, 65–75 and > 75 years). Within group adjusted hazard ratios for death in older compared to younger patients were calculated for different primary renal diseases. A competing risk model of death and renal replacement therapy (RRT) as outcomes was performed.ResultsThe median age of the cohort was 67.1 years [interquartile range (IQR): 55.6–75.3] and median eGFR 30.8 ml/min/1.73 m2 (IQR: 20.6–43.2). Follow up was 3.5 ± 2.9 years. Overall, the adjusted HR for death in patients aged > 75 years compared to those < 55 years was 4.4 (95% CI 3.4–5.9), p < 0.001. The HR for death differed between primary renal diseases and CKD stages. In diabetic nephropathy, the HR was 3.0 (1.8–5.3, p < 0.001), in glomerulonephritis the HR was 12.2 (5.6–25.5, p < 0.001). The cumulative incidence of RRT was < 0.1 at 10 years for patients > 75 years, compared with 0.50 in those < 55 years. Death was more likely at 20 months in those aged 75 years or older (0.17) than at 10 years in those aged < 55 years (0.10).ConclusionThis study demonstrates that the risk associated with older age shows significant variability between primary renal diseases. This is whilst acknowledging that observational studies carry the risk of hidden bias not adjusted for in the statistical model.Electronic supplementary materialThe online version of this article (10.1007/s40620-018-0529-8) contains supplementary material, which is available to authorized users.

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“…A study by Zachariah et al . () showed that people aged >75 years of age received fewer secondary preventive measures compared with younger subjects on discharge, following a percutaneous coronary intervention (PCI) (p < 0.01 for beta blocker, ACE‐i/ARB and statin). Amongst people with eGFR <60 ml/min/1.73 m 2 , only 83.5% received either an ACE‐I or ARB at discharge.…”

Section: Influence Of Medications Upon Cardiovascular and Renal Outcomentioning

confidence: 99%

Older People With Chronic Kidney Disease: Definition, and Influence of Biomarkers and Medications Upon Cardiovascular and Renal Outcomes

Raman

Green

Middleton

et al. 2016

Journal of Renal Care

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The impact of age and chronic kidney disease on secondary prevention post-primary percutaneous coronary intervention

Abstract: The uptake of secondary prevention medication is high following PPCI in the UK, even in the elderly and in those with renal dysfunction. A focus on strategies to improve up-titration and continuation of drugs following discharge is required.

Cited by 7 publications

References 14 publications

Impact of Chronic Kidney Disease on Use of Evidence-Based Therapy in Stable Coronary Artery Disease: A Prospective Analysis of 22,272 Patients

Impact of Chronic Kidney Disease on Use of Evidence-Based Therapy in Stable Coronary Artery Disease: A Prospective Analysis of 22,272 Patients

Comparing the impact of older age on outcome in chronic kidney disease of different etiologies: a prospective cohort study

Older People With Chronic Kidney Disease: Definition, and Influence of Biomarkers and Medications Upon Cardiovascular and Renal Outcomes

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