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.
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 HDpatients with left ventricular dysfunction (LVDys) and patients' post-acute coronary syndrome. DESIGN: Incident HDpatients 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.
Authors: Carmine Zoccali; Francesco Antonio Benedetto; Francesca Mallamaci; Giovanni Tripepi; Giuseppe Giacone; Alessandro Cataliotti; Giuseppe Seminara; Benedetta Stancanelli; Lorenzo Salvatore Malatino Journal: J Am Soc Nephrol Date: 2001-12 Impact factor: 10.121
Authors: J N Cohn; G Johnson; S Ziesche; F Cobb; G Francis; F Tristani; R Smith; W B Dunkman; H Loeb; M Wong Journal: N Engl J Med Date: 1991-08-01 Impact factor: 91.245
Authors: Christoph Wanner; Vera Krane; Winfried März; Manfred Olschewski; Johannes F E Mann; Günther Ruf; Eberhard Ritz Journal: N Engl J Med Date: 2005-07-21 Impact factor: 91.245
Authors: Debasish Banerjee; Gabriel Contreras; Isabel Jaraba; Decio Carvalho; Luis Ortega; Cristiane Carvalho; Candido Pezon; Stephen P Rosenthal; Norman De La Rosa; Nuripama Vemuri; Gautam Cherla; Nilay Nahar Journal: Int Urol Nephrol Date: 2009-01-01 Impact factor: 2.370
Authors: Kosmas I Paraskevas; Sotirios A Koupidis; Alexandros A Tzovaras; Achilleas Nikolaou; Dimitri P Mikhailidis Journal: Int Urol Nephrol Date: 2011-01-06 Impact factor: 2.370
Authors: Tara I Chang; Yuanchao Zheng; Maria E Montez-Rath; Wolfgang C Winkelmayer Journal: Clin J Am Soc Nephrol Date: 2016-06-27 Impact factor: 8.237
Authors: James B Wetmore; Jonathan D Mahnken; Purna Mukhopadhyay; Qingjiang Hou; Edward F Ellerbeck; Sally K Rigler; John A Spertus; Theresa I Shireman Journal: Am J Kidney Dis Date: 2011-05-31 Impact factor: 8.860
Authors: Nicolas Rognant; Eric Alamartine; Jean Claude Aldigier; Christian Combe; Benoit Vendrely; Patrice Deteix; Pascal Cluzel; Laurent Juillard; François Vrtovsnik; Christelle Maurice; Sophie Fave; Maurice Laville Journal: BMC Nephrol Date: 2013-02-20 Impact factor: 2.388
Authors: Wendy L St Peter; Stephen M Sozio; Tariq Shafi; Patti L Ephraim; Jason Luly; Aidan McDermott; Karen Bandeen-Roche; Klemens B Meyer; Deidra C Crews; Julia J Scialla; Dana C Miskulin; Navdeep Tangri; Bernard G Jaar; Wieneke M Michels; Albert W Wu; L Ebony Boulware Journal: BMC Nephrol Date: 2013-11-12 Impact factor: 2.388