Kidney Disease Linked To Lower Medication Use After Heart Attack
Main Category: Urology / NephrologyAlso Included In: Cardiovascular / Cardiology
Article Date: 10 Jul 2008 - 1:00 PDT
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Patients with kidney disease especially end-stage renal disease (ESRD) requiring dialysis are less likely to receive recommended medications after a heart attack, reports a study in the September 2008 Clinical Journal of the American Society of Nephrology (CJASN).
"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," comments Dr. Wolfgang C. Winkelmayer of Brigham and Women's Hospital in Boston, MA. "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 analyzed data on medication use after a heart attack, or myocardial infarction, in approximately 21,500 patients. Seventeen percent of the patients had CKD loss of kidney function that, in many cases, progresses to ESRD. Another two percent had ESRD permanent loss of kidney function requiring dialysis or transplantation.
Patients with and without kidney disease were compared for use of medications recommended after myocardial infarction: beta-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs/ARBs), and cholesterol-lowering "statin" drugs. Along with aspirin, these three types of drugs are an important part of strategies to prevent further events after myocardial infarction.
Overall rates of medication use were low: after leaving the hospital, just 27 percent of patients filled a prescription for a statin drug. Forty-four percent started treatment with ACEIs/ARBs and 57 percent with beta-blockers.
After adjustment for other factors, patients with CKD were 22 percent less likely to start beta-blocker treatment, compared to patients without kidney disease. There was no difference in ACEI/ARB or statin use.
For ESRD patients, rates of medication use were even lower: 43 percent lower for ACEIs/ARBs and 17 percent lower for statins. (Patients with ESRD were also less likely to start beta-blocker treatment, although the difference wasn't significant.)
Among patients who filled a first prescription, rates of continued medication use after one year were 64 percent for beta-blockers, 57 percent for statins, and 54 percent for ACEIs/ARBs. For all three 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," says 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.
Over time, rates of adherence to all three types of medications for myocardial infarction are surprisingly low for patients with and without kidney disease. Especially 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, the researchers conclude.
The study was limited by a lack of data on vital and laboratory measurements. This included tests to confirm the presence of kidney disease, which was ascertained from health care claims.
This work was supported by an American Heart Association Scientist Development Grant (0535232N) and a Norman S. Coplon Extramural Research Program Award from Satellite Research to Dr. Winkelmayer.
The article, entitled "Associations of Kidney Function with Cardiovascular Medication use After Myocardial Infarction," will appear online at http://cjasn.asnjournals.org/ on Wednesday, July 9, 2008, and in the September 2008 print issue of CJASN.
A not-for-profit organization of 11,000 physicians and scientists dedicated to the study of nephrology, ASN is committed to providing a forum regarding the latest research and clinical information about kidney diseases. ASN publishes the CJASN, the Clinical Journal of the American Society of Nephrology (JASN), and the Nephrology Self-Assessment Program (NephSAP). In January 2009, the Society will launch ASN Kidney News, a newsmagazine for nephrologists, scientists, allied health professionals, and staff.
American Society of Nephrology (ASN)
1725 I St., NW, Ste 510
Washington, DC 20006
United States
http://www.asn-online.org
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46 Year Old Life-Saving Centers
posted by Dan on 10 Jul 2008 at 10:49 amAn Artificial Kidney for those Who Have Failed Kidneys: The Dialysis Machine
Kidneys are necessary human organs, which is probably why humans have two of them, as they are balancing organs for our well being, from a physiological perspective. They remove toxins for the blood and maintain electrolyte balance in our bodies as well, to name a few of the many functions of these what are termed end or target organs that are dependent on our circulatory system as we are dependent on their optimal function for our existence.
While the process of dialysis has been improved over the past century or two, the first actual dialysis center was created by a man named Belding Scribner in the early 1960s. Rumor has it that he never patented his creation so more could have access to this vital procedure location with trained staff. Lately, some for profit centers, such as Gambro Healthcare, have gotten busted for over-billing the government at their locations. Somewhat ironical.
About ˝ a million people are dependent on dialysis devices annually and the cost is completely covered by those with Medicare, as this cost for this treatment approaches or exceeds tens of billions of dollars a year for all of these types of patients. In fact, this is the only medical treatment that s completely financially covered chronic medical treatment by Medicare since the early 1970s. This cost is about a million dollars per patient per year. Hem dialysis is the most beneficial type of dialysis, which removes toxins from the blood of the patient over a period of a few hours about three or four times a week, with anemia being the most common complication of this treatment.
If there are patients who need financial assistance, there is a support group and their web site is: http://www.aakp.org . They may have helped more dialysis patients financially than any other support group.
While there are now about 5 thousand independent and hospital owned dialysis centers presently in the United States, there is also the possibility of home dialysis that are options as well, as determined by the dialysis patient’s doctor, who is a nephrologist, or kidney doctor.
Non for profit dialysis centers have been shown to have better quality than the for profit centers for a number of reasons- some of which are entirely known and unknown. This is important because monitoring of kidney failure patients is a great responsibility, as the average patient takes about 10 drugs routinely in addition to dialysis treatment and are chronically sick patients typically.
One reason for the large number of medications taken by these patients is due to the two primary causes of kidney failure, which are uncontrolled hypertension and diabetes. With high blood pressure, over time the kidneys become progressively impaired due to nephrosclerosis, which is nephritis that is caused, or causes, restricted blood flow and possibly toxins that aggravate this condition within the failing kidneys of these patients. With diabetes, most can discover the disease by detecting protein in the urine, which is a quite simple urine test. If uncontrolled, diabetic nephropathy develops and progresses to the point of kidney failure. Most dialysis patients are there because of diabetes related effects from under treatment or absence of treatment.
How it is determined regarding the damage of the kidneys of such patients is measured by the suspected kidney impaired patient by their GFR- gloumular filtration rate, which measures their fluid output of these patients. If a patient reaches a GFR of stage5, they usually are placed on dialysis for life support, essentially.
For unclear reasons, the larger the size of a dialysis center, the better patient compliance will be experienced, which means more patients show up for treatment and follow directed protocol regarding their illness.
In addition, nephrology staff members of such centers, which include nephrology nurses, have increasingly greater responsibility. Such courageous and skilled people freely accept rather challenging professions that some are reluctant to challenge themselves in such a way. There is actually an American Nephrology Nurses Association. And there is a dialysis museum in Wisconsin called something close to Dialysis Central.
Aggressively treating dialysis patients is controversial. One issue is those patients with CV disease, as overly aggressive dialysis treatment has been correlated with premature death.
Technology and quality of life continues to improve for these patients, yet an artificial kidney would be great, once developed. This has not become available yet. So as you may have surmised, those who treat such patients in a very complex way considering several variables takes those who are passionate about their involvement.
So, if you are a health care professional who wishes to challenge themselves and gain the confidence of nephrologists. I would suggest involvement with such a devastating disease that relies on quality and compassionate staff for their livelihood and appropriate treatment. Of course, this means dealing with the stress of treating kidney failure patients.
“Only those who risk going too far with deliberate intent can possibly discover how far they can actually go.” --- T.S. Elliott
Dan Abshear (What has been written is based upon information and belief)
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