Invasive Cardiac Care for CKD Patients

The results of the study were reported during a poster session at NKF SCM22. The poster was titled Lower use of invasive cardiac care in patients with stage 3 and 4 chronic kidney disease admitted with acute coronary syndrome in a tertiary health care system.

Patients hospitalized for ACS (ST-segment elevation myocardial infarction) [STEMI] or NSTEMI) between January 1, 2016 and December 31, 2019, were included in the study. Patients with stage 5 CKD or end-stage renal disease were excluded, as were patients with DNR prescriptions or palliative care consultations. International Classification of Diseases – Tenth Revision (ICD-10) the primary reject codes were used to identify the SCA, and Current procedural terminology (PTC) and ICD-10 Procedure Coding System codes were used to identify CA, PCI and CABG procedures

Multivariate logistic regression was used to compare the use of invasive care according to CKD status. Cox risk models were used to compare mortality

The study included 2316 NSTEMI patients and 478 STEMI patients. Of the total cohort, 540 patients had a diagnosis of CKD. Patients with CKD were more likely to be older (78 vs. 71; PPPP<.001 compared to those without ckd.>

After adjusting for age, race, gender, and diagnosis of diabetes mellitus, hypertension, and history of stroke, patients with CKD were 32% less likely to undergo invasive cardiovascular procedures than those without CRI (odds ratio adjusted [aOR], 0.68; 95% confidence interval [CI], 0.54-0.87). The percentage of NSTEMI patients undergoing invasive cardiovascular procedures decreased with increasing CKD severity (83% vs. 76% vs. 68%; P<.001 the aor for invasive cardiovascular procedures in patients with ckd compared to without was ci>

In the CKD group and the non-CKD group, there was an improvement in survival with invasive cardiovascular procedures observed. The adjusted hazard ratio for death at 5 years with the completion of the procedure was 0.63 (95% CI, 0.45-0.88) in patients with CKD compared to 0.42 (CI 95%, 0.33-0.53) in patients without CKD.

In summary, the authors stated, “In a contemporary cohort of patients treated in a large tertiary referral hospital system, patients with CKD are less likely to undergo invasive care to treat ACS, despite decreased mortality. with such treatment.

Source: Kapoor S, Weisbord S. Lower use of invasive cardiac care in patients with stage 3 and 4 chronic kidney disease admitted with acute coronary syndrome to a tertiary health care system. Abstract of a poster (Poster #182) presented at the National Kidney Foundation Spring 2022 Clinical Meetings, Boston, Massachusetts, April 6-10, 2022.

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