Kidney Disease Linked to Lower Medication Use After Heart Attack

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Title: Kidney Disease Linked to Lower Medication Use After Heart Attack
URL: http://www.pslgroup.com/dg/22558E.htm
Doctor's Guide
July 9, 2008

WASHINGTON, DC -- July 9, 2008 -- Patients with kidney disease, especially end-stage renal disease (ESRD) requiring dialysis, are less likely to receive recommended medications after myocardial infarction, according to a study in the September 2008 issue of Clinical Journal of the American Society of Nephrology.

"This is the first systematic report to investigate whether kidney function is associated with use of and adherence with medications that are recommended for secondary prevention after a heart attack," said Wolfgang C. Winkelmayer, MD, Brigham and Women's Hospital, Boston, Massachusetts.

"We found that use of several medications after a heart attack was lower in patients with chronic kidney disease [CKD] or ESRD. However, 1-year adherence did not differ by kidney function."

The researchers analysed data on medication use after a myocardial infarction in approximately 21,500 patients. Of the patients, 17% had CKD and 2% had ESRD.

Patients with and without kidney disease were compared for use of medications recommended after myocardial infarction. Medications included beta-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs/ARBs), and statins.

The analysis found that overall rates of medication use were low. After leaving the hospital, only 27% of patients filled a prescription for a statin drug, 44% started treatment with ACEIs/ARBs, and 57% with beta-blockers.

After adjustment for other factors, patients with CKD were 22% less likely to start beta-blocker treatment compared with patients without kidney disease. There was no difference in ACEI/ARB or statin use. For patients with ESRD, rates of ACEI/ARB use was 43% lower and rates for statin drug use was 17% lower.

Among patients who filled a first prescription, rates of continued medication use after 1 year was 64% for beta-blockers, 57% for statins, and 54% for ACEIs/ARBs. For all 3 types of drugs, adherence rates were similar for patients with and without CKD. Patients with ESRD were less likely to continue beta-blocker treatment.

The results may help in understanding how medications affect the relationship between kidney disease and cardiovascular disease. "Kidney function is a well-established risk factor for cardiovascular events such as heart attacks and is also associated with a worse prognosis after such events," said Dr. Winkelmayer.

"One possible explanation is differences in health service delivery. It may be that patients with more advanced kidney function receive less state-of-the art care after a heart attack, including less acute coronary intervention, less acute medical intervention, and less chronic, secondary prevention."

The results also show some important differences in medication use after myocardial infarction by patients with kidney disease, particularly ESRD. However, these differences don't appear to explain the higher cardiovascular risk among patients with low kidney function.

According to the researchers, as rates of kidney disease continue to rise, new ways of reducing cardiovascular risk among patients with low kidney function should be a top priority.

SOURCE: American Society of Nephrology

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