Kidney Disease Linked to Lesser Care

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Hospitalized cardiac patients with renal failure may be less likely to get appropriate medications.

 

CHICAGO —Two studies suggest that physicians need to pay attention to renal insufficiency in hospitalized patients with cardiac conditions.

 

One study focused on about 85,000 patients enrolled in the National Registry of Myocardial Infarction 5. Of these, about 20,000 had renal failure, and these patients had a greater frequency of comorbidities (history of hypertension, MI, heart failure, diabetes, stroke, peripheral vascular disease, and pulmonary edema) compared with patients without renal failure.

 

Additionally, patients with renal failure were less likely to be treated with appropriate medications, such as ACE inhibitors, beta blockers, aspirin, clopidogrel, and statins, and less likely to undergo coronary revascularization.

 

Rates of in-hospital death and major adverse cardiac events were lower in renal failure patients treated with ACE inhibitors, beta blockers, aspirin, and clopidogrel, but higher in those treated with diuretics and GP IIb/IIIa inhibitors. The highest rates of death and cardiac events were observed in patients with moderate renal failure, according to investigator Santhosh K. Koshy, MD, of Baylor College of Medicine in Houston.

 

Independent predictors of in-hospital death in those with renal failure were ST elevation, MI, ST depression, left bundle branch block, heart failure, history of stroke, peri-pheral vascular disease, diabetes, and older age. Independent predictors for major cardiac events in those with renal failure were the presence of ST elevation, ST depression, heart failure, history of angina, coronary revascularization, stroke, and peripheral vascular disease.

 

Renal impairment unrecognized

The other study, of 4,102 hospitalized patients with heart failure, showed that 2,145 patients

had renal insufficiency, defined as an estimated glomerular filtration rate less than 60 mL/min per 1.73m2. The condition was clinically unrecognized, however, in 872 of them (41%).

 

“Our data suggest a need for careful screening to recognize renal insufficiency and to apply effective preventive treatment in those high-risk patients,” said Yoram Amselem, MD, of Neufeld Cardiac Research Insti-tute in Tel Aviv, Israel.

 

Those with unrecognized renal insufficiency were significantly more likely to be older women than patients with recognized renal insufficiency. The study revealed higher in-hospital and one-year mortality in patients with both recognized and unrecognized renal insufficiency compared with those with preserved renal function.

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