BACKGROUND: Limited data are available on the use of potentially cardioprotective medications among U.S. kidney transplant recipients. METHODS: We constructed a database wherein Organ Procurement and Transplant Network identifiers for kidney transplant recipients were linked to billing records of a private health insurer (2003-2006 claims). Transplant recipients and general beneficiaries with acute myocardial infarction (AMI) events were identified by diagnosis codes. The healthcare process measures of interest comprised prescription fills for beta-blockers, antiplatelet drugs, angiotensin-converting enzyme inhibitors/angiotensin-2 receptor blockers, and β-hydroxy-β-methylglutaryl coenzyme A (HMG CoA) reductase inhibitors (statins) within 60 days after AMI. Medication use was compared in transplant and general patients by multivariable regression and by one-to-one matching for demographic and clinical factors including comorbidities and revascularization status. RESULTS: We identified 192 kidney transplant recipients and 52,021 general patients who survived with insurance benefits more than or equal to 60 days after AMI diagnosis. In multiple logistic regression, transplant status was independently associated with increased likelihood of beta-blocker (adjusted odds ratio, 2.50; 95% confidence interval, 1.70-3.68; P<0.0001) and statin (adjusted odds ratio, 1.78; 95% confidence interval, 1.28-2.48; P=0.0006) use after AMI. Similarly kidney transplant recipients with AMI more commonly received beta-blockers (83.0% vs. 65.9%; P=0.0001) and statins (72.0% vs. 62.6%; P=0.04) compared with matched controls. Use of antiplatelet agents and angiotensin-converting enzyme inhibitors/angiotensin-2 receptor blockers did not differ significantly by transplant status. CONCLUSIONS: Although kidney transplant status does not seem to be a barrier to medication use after AMI, there may be opportunities for improving cardiovascular risk management in high-risk transplant recipients. Administrative records offer a practical tool for monitoring cardiovascular complications and healthcare delivery not tracked in national registries.
BACKGROUND: Limited data are available on the use of potentially cardioprotective medications among U.S. kidney transplant recipients. METHODS: We constructed a database wherein Organ Procurement and Transplant Network identifiers for kidney transplant recipients were linked to billing records of a private health insurer (2003-2006 claims). Transplant recipients and general beneficiaries with acute myocardial infarction (AMI) events were identified by diagnosis codes. The healthcare process measures of interest comprised prescription fills for beta-blockers, antiplatelet drugs, angiotensin-converting enzyme inhibitors/angiotensin-2 receptor blockers, and β-hydroxy-β-methylglutaryl coenzyme A (HMG CoA) reductase inhibitors (statins) within 60 days after AMI. Medication use was compared in transplant and general patients by multivariable regression and by one-to-one matching for demographic and clinical factors including comorbidities and revascularization status. RESULTS: We identified 192 kidney transplant recipients and 52,021 general patients who survived with insurance benefits more than or equal to 60 days after AMI diagnosis. In multiple logistic regression, transplant status was independently associated with increased likelihood of beta-blocker (adjusted odds ratio, 2.50; 95% confidence interval, 1.70-3.68; P<0.0001) and statin (adjusted odds ratio, 1.78; 95% confidence interval, 1.28-2.48; P=0.0006) use after AMI. Similarly kidney transplant recipients with AMI more commonly received beta-blockers (83.0% vs. 65.9%; P=0.0001) and statins (72.0% vs. 62.6%; P=0.04) compared with matched controls. Use of antiplatelet agents and angiotensin-converting enzyme inhibitors/angiotensin-2 receptor blockers did not differ significantly by transplant status. CONCLUSIONS: Although kidney transplant status does not seem to be a barrier to medication use after AMI, there may be opportunities for improving cardiovascular risk management in high-risk transplant recipients. Administrative records offer a practical tool for monitoring cardiovascular complications and healthcare delivery not tracked in national registries.
Authors: Krista L Lentine; Abhijit S Naik; Rosemary Ouseph; Zidong Zhang; David A Axelrod; Dorry L Segev; Vikas R Dharnidharka; Daniel C Brennan; Henry Randall; Raj Gadi; Ngan N Lam; Gregory P Hess; Bertram L Kasiske; Mark A Schnitzler Journal: Transpl Int Date: 2017-08-03 Impact factor: 3.782
Authors: Krista L Lentine; Anitha Vijayan; Huiling Xiao; Mark A Schnitzler; Connie L Davis; Amit X Garg; David Axelrod; Kevin C Abbott; Daniel C Brennan Journal: Transplantation Date: 2012-07-27 Impact factor: 4.939
Authors: Amit K Mathur; Yu-Hui Chang; D Eric Steidley; Raymond Heilman; Narjeet Khurmi; Nabil Wasif; David Etzioni; Adyr A Moss Journal: Transplant Direct Date: 2017-01-16
Authors: Amit K Mathur; Yu-Hui Chang; D Eric Steidley; Raymond L Heilman; Nabil Wasif; David Etzioni; Kunam S Reddy; Adyr A Moss Journal: BMC Nephrol Date: 2019-05-28 Impact factor: 2.388