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Guideline-Directed Medical Therapy Attainment and Outcomes in Dialysis-Requiring Versus Nondialysis Chronic Kidney Disease in the ISCHEMIA-CKD Trial. | LitMetric

AI Article Synopsis

  • - Patients with chronic kidney disease on dialysis (CKD G5D) experience poorer cardiovascular outcomes compared to those with advanced non-dialysis CKD (CKD G4-5) and their response to guideline-directed medical therapy (GDMT) is being evaluated for better clinical outcomes.
  • - A study analyzed participants with moderate-to-severe heart issues, comparing the effectiveness of GDMT goals like smoking cessation and blood pressure control in those with CKD G5D versus CKD G4-5.
  • - Results showed CKD G5D patients were less likely to receive essential treatments like statins and aspirin, but achieving more GDMT goals overall led to a significant decrease in risks of mortality and heart attacks regardless of dialysis status

Article Abstract

Background: Patients with chronic kidney disease (CKD) on dialysis (CKD G5D) have worse cardiovascular outcomes than patients with advanced nondialysis CKD (CKD G4-5: estimated glomerular filtration rate <30 mL/[min·1.73m]). Our objective was to evaluate the relationship between achievement of cardiovascular guideline-directed medical therapy (GDMT) goals and clinical outcomes for CKD G5D versus CKD G4-5.

Methods: This was a subgroup analysis of ISCHEMIA-CKD (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches-Chronic Kidney Disease) participants with CKD G4-5 or CKD G5D and moderate-to-severe myocardial ischemia on stress testing. Exposures included dialysis requirement at randomization and GDMT goal achievement during follow-up. The composite outcome was all-cause mortality or nonfatal myocardial infarction. Individual GDMT goal (smoking cessation, systolic blood pressure <140 mm Hg, low-density lipoprotein cholesterol <70 mg/dL, statin use, aspirin use) trajectory was modeled. Percentage point difference was estimated for each GDMT goal at 24 months between CKD G5D and CKD G4-5, and for association with key predictors. Probability of survival free from all-cause mortality or nonfatal myocardial infarction by GDMT goal achieved was assessed for CKD G5D versus CKD G4-5.

Results: A total of 415 CKD G5D and 362 CKD G4-5 participants were randomized. Participants with CKD G5D were less likely to receive statin (-6.9% [95% CI, -10.3% to -3.7%]) and aspirin therapy (-3.0% [95% CI, -5.6% to -0.6%]), with no difference in other GDMT goal attainment. Cumulative exposure to GDMT achieved during follow-up was associated with reduction in all-cause mortality or nonfatal myocardial infarction (hazard ratio, 0.88 [95% CI, 0.87-0.90]; per each GDMT goal attained over 60 days), irrespective of dialysis status.

Conclusions: CKD G5D participants received statin or aspirin therapy less often. Cumulative exposure to GDMT goals achieved was associated with lower incidence of all-cause mortality or nonfatal myocardial infarction in participants with advanced CKD and chronic coronary disease, regardless of dialysis status.

Registration: URL: https://www.

Clinicaltrials: gov; Unique identifier: NCT01985360.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9588677PMC
http://dx.doi.org/10.1161/CIRCOUTCOMES.122.008995DOI Listing

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