Skip to main content
SpringerLink
Log in

Patterns of cardioprotective medication prescription in incident hemodialysis patients

  • Nephrology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Background

There is a lack of evidence to guide medical decision making regarding cardiac medication therapy in hemodialysis (HD) patients. The aim of the study was to describe cardioprotective medication prescription patterns in incident HD patients with left ventricular dysfunction (LVDys) and patients’ post-acute coronary syndrome.

Design

Incident HD patients between January 2002 and December 2004 were included and followed until 2007 or death. Data extraction was retrospective by means of electronic chart review and from a local dialysis database.

Results

A total of 272 patients were included for analysis; 104 of them (38%) had LVDys. Patients with severe LVDys (EF < 40%) were more likely to be prescribed angiotensin converting enzyme inhibitors (55.8 vs. 39.1%, P = 0.051), beta-blockers (81.4 vs. 62.4%, P = 0.018), statins (60.5 vs 38.3%, P = 0.009), ASA (37.2 vs 21%, P = 0.27) and clopidogrel (16.3 vs. 3%, P = 0.001). Sixty-five (24%) suffered an acute coronary syndrome (ACS) and were prescribed ACE inhibitors (57 vs. 38%, P = 0.006), beta-blockers (85 vs. 59%, P = NS), short-acting nitrates (14.0 vs. 2.0%, P < 0.0001), statin (65 vs. 36%, P < 0.0001), clopidogrel (25 vs. 2%, P < 0.0001) and ASA (60 vs. 18%, P < 0.0001). Using multiple logistic regression, LVDys was associated with mortality (OR 1.79, CI 100–3.21, P = 0.05), beta-blockers conferred a mortality benefit (OR 0.50, CI 0.27–0.93, P < 0.0001) and ACE inhibitors, angiotensin receptor blockers, statins and clopidogrel were not statistically significant.

Conclusions

Hemodialysis patients with LVDys and ACS were commonly prescribed cardiac medications despite the poor level of direct evidence. Only beta-blockers were associated with improvements in mortality. Nephrologists practice patterns are based on extrapolations of the evidence from the non-ESRD population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. (2005) K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. Am J Kidney Dis 45(suppl 3):16–153

  2. Foley RN, Parfrey PS, Hartnett JD et al (1995) Clinical and echocardiographic disease in patients starting end-stage renal disease therapy. Kidney Int 47:186–192

    Article  CAS  PubMed  Google Scholar 

  3. Harnett JD, Foley RN, Kent GM et al (1995) Congestive heart failure in dialysis patients: prevalence, incidence, prognosis and risk factors. Kidney Int 47:884–890

    Article  CAS  PubMed  Google Scholar 

  4. Parfrey PS, Foley RN, Harnett JD et al (1996) Outcome and risk factors of ischemic heart disease in chronic uremia. Kidney Int 49:1428–1434

    Article  CAS  PubMed  Google Scholar 

  5. Zoccali C, Benedetto FA, Mallamaci F et al (2001) Prognostic impact of the indexation of left ventricular mass in patients undergoing dialysis. J Am Soc Nephrol 12:2768–2774

    CAS  PubMed  Google Scholar 

  6. Cohn JN, Johnson G, Ziesche S et al (1991) A comparison of enalapril with hydralazine-isosorbide dinitrate in the treatment of chronic congestive heart failure. N Engl J Med 325:303–310

    CAS  PubMed  Google Scholar 

  7. Cohn JN, Archibald DG, Ziesche S et al (1986) Effect of vasodilator therapy on mortality in chronic congestive heart failure. Results of a veterans administration cooperative study. N Engl J Med 314:1547–1552

    CAS  PubMed  Google Scholar 

  8. Garg R, Yusuf S (1995) Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. Collaborative group on ACE inhibitor trials. JAMA 273:1450–1456

    Article  CAS  PubMed  Google Scholar 

  9. Pitt B, Zannad F, Remme RJ et al (1999) The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized aldactone evaluation study investigators. N Engl J Med 341:709–717

    Article  CAS  PubMed  Google Scholar 

  10. Cohn JN, Tognoni G (2001) A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure. N Engl J Med 345:1667–1675

    Article  CAS  PubMed  Google Scholar 

  11. Poole-Wilson PA, Swedberg K, Cleland JGF et al (2003) Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the carvedilol or metoprolol European trial (COMET): randomised controlled trial. Lancet 362:7–13

    Article  CAS  PubMed  Google Scholar 

  12. Hood BW, Dans LA (2004) Digitalis for treatment of congestive heart failure in patients in sinus rhythm: a systematic review and meta-analysis. J Card Fail. 10:155–164

    Article  CAS  PubMed  Google Scholar 

  13. Banerjee D, Contreras G, Jaraba I et al (2009) Chronic kidney disease stages 3–5 and cardiovascular disease in the veterans affairs population. Int Urol Nephrol 41(2):443–451

    Article  PubMed  Google Scholar 

  14. Ogawa T, Ishida H, Akamatsu M et al (2009) Progression of aortic arch calcification and all-cause and cardiovascular mortality in chronic hemodialysis patients. Int Urol Nephrol. doi:10.1007/s11255-009-9574-5

    Google Scholar 

  15. Turkmen F, Emre A, Ozdemir A et al (2008) Relationship between aortic valve sclerosis and left ventricular hypertrophy in chronic haemodialysis patients. Int Urol Nephrol 40(2):497–502

    Article  PubMed  Google Scholar 

  16. Cice G, Ferrara L, Di Benedetto A et al (2001) Dilated cardiomyopathy in dialysis patients–beneficial effects of carvedilol: a double-blind, placebo-controlled trial. J Am Coll Cardiol 37:407–411

    Article  CAS  PubMed  Google Scholar 

  17. Cice G, Ferrara L, Di Benedetto A et al (2003) Carvedilol increases two-year survival in dialysis patients with dilated cardiomyopathy: a prospective, placebo-controlled trial. J Am Coll Cardiol 41:1438–1444

    Article  CAS  PubMed  Google Scholar 

  18. Wanner C, Krane V, Marz W et al (2005) Atorvastatin in patients with type 2 diabetes mellitus undergoing hemodialysis. N Engl J Med 353:238–248

    Article  CAS  PubMed  Google Scholar 

  19. Fellstrom BC, Jardine A, Schmeider R et al (2009) Rosuvastatin and cardiovascular events in patients undergoing hemodialysis. N Engl J Med 360(14):1395–1407

    Article  CAS  PubMed  Google Scholar 

  20. Miller LM, Hopman WM, Garland J et al (2006) Cardioprotective medication use in hemodialysis patients. Can J Cardiol 22:755–760

    PubMed  Google Scholar 

  21. Roy P, Bouchard J, Amyot R et al (2007) Prescription patterns for left ventricular systolic dysfunction among hemodialysis patients. Am J Kidney Dis 48(4):645–651

    Article  Google Scholar 

  22. Zannad F, Kessler R, Lehert P et al (2006) Prevention of cardiovascular events in end stage renal disease: results of a randomized trial in fosinopril and implications for future studies. Kidney Int 70:1318–1324

    Article  CAS  PubMed  Google Scholar 

  23. Navaneethan SD, Perkovic V, Manno C et al (2009) HMG CoA reductase inhibitors (statins) for people with chronic kidney disease not requiring dialysis. Cochrane Database Syst Rev 2009(2):CD007784

    Google Scholar 

  24. Berger AK, Duval S, Krumholz HM et al (2003) Aspirin, beta-blocker and angiotensin-converting enzyme inhibitor therapy in patients with end-stage renal disease and an acute myocardial infarction [comment]. J Am Coll Cardiol 42:201–208

    Article  CAS  PubMed  Google Scholar 

  25. Winkelmayer WC, Charytan DM, Levin R et al (2006) Poor short-term survival and low use of cardiovascular medications in elderly dialysis patients after acute myocardial infarction. Am J Kidney Dis 47:301–308

    Article  PubMed  Google Scholar 

  26. Knoll GA, Sahgal A, Nair RC et al (2002) Renin-angiotensin system blockade and the risk of hyperkalemia in chronic hemodialysis patients. Am J Med 112:110–114

    Article  CAS  PubMed  Google Scholar 

  27. Iseki K, Yamazato M, Tozawa M et al (2002) Hypocholesterolemia is a significant predictor of death in a cohort of chronic hemodialysis patients. Kidney Int 61:1887–1893

    Article  PubMed  Google Scholar 

  28. Kanegae K, Hiroshige K, Suda T et al (1999) Pharmacokinetics of bisoprolol and its effect on dialysis refractory hypertension. Int J Artif Organs 22:798–804

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. St. Boniface Hospital and the University of Manitoba, Bg007, 409 Tache Avenue, Winnipeg, MB, Canada

    Manish M. Sood

  2. University Health Network, Toronto General Hospital and the University of Toronto, Toronto, ON, Canada

    Manish M. Sood, Marisa Battistella & Charmaine E. Lok

Authors
  1. Manish M. Sood
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marisa Battistella
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Charmaine E. Lok
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Manish M. Sood.

Additional information

All authors have contributed and reviewed this manuscript.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sood, M.M., Battistella, M. & Lok, C.E. Patterns of cardioprotective medication prescription in incident hemodialysis patients. Int Urol Nephrol 41, 1021–1027 (2009). https://doi.org/10.1007/s11255-009-9606-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-009-9606-1

Keywords

Search

Navigation