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. 2011 Dec 31;7(6):984-92.
doi: 10.5114/aoms.2011.26610. Epub 2011 Dec 30.

IMproving the imPlemEntation of cuRrent guidelines for the mAnagement of major coronary hearT disease rIsk factors by multifactorial interVEntion. The IMPERATIVE renal analysis

Vasilios G Athyros  1 , Apostolos I Hatzitolios, Asterios Karagiannis, Christos Savopoulos, Niki Katsiki, Konstantinos Tziomalos, Aikaterini Papagianni, Anna Kakafika, Thomas D Gossios, Dimitri P Mikhailidis; IMPERATIVE Collaborative Group
Affiliations

IMproving the imPlemEntation of cuRrent guidelines for the mAnagement of major coronary hearT disease rIsk factors by multifactorial interVEntion. The IMPERATIVE renal analysis

Vasilios G Athyros et al. Arch Med Sci. .

Abstract

Introduction: The short-term effects of multifactorial intervention for cardiovascular disease (CVD) prevention on renal function and serum uric acid (SUA) levels in patients with stage 3 chronic kidney disease (CKD) and multiple CVD risk factors are unclear. The aim of the study was to prospectively assess these effects.

Material and methods: This post hoc analysis of 5 "best practice" studies involved patients with multiple CVD risk factors. Estimated glomerular filtration rate (eGFR) was assessed using the Modification of Diet in Renal Disease (MDRD) formula. Among the 4,153 patients, 1,235 (29.7%) had stage 3 CKD (eGFR between 30 and 59 ml/min/1.73 m(2)). A baseline visit was followed by a concerted effort from previously trained physicians to improve adherence to lifestyle advice and optimize drug treatment, including a statin, for all vascular risk factors. After 6 months eGFR and SUA levels were re-evaluated.

Results: The intervention improved compliance to lifestyle measures and increased the use of evidence-based medication, including a statin. There was also a 5.6% increase in eGFR (p < 0.001) in patients with stage 3 CKD and a 6.1% reduction in SUA levels (p < 0.001). Among patients with stage 3 CKD, 127 (10.3%) improved to stage 2 CKD and 9 (0.7%) advanced to stage 4 CKD by the end of the 6-month study period. There were no major side-effects.

Conclusions: Multitargeted intervention, including a statin, may improve renal function and reduce SUA levels within 6 months, thus offsetting 2 potential CVD risk factors in high-risk patients.

Keywords: diabetes mellitus; dyslipidaemia; hypertension; metabolic syndrome; multifactorial intervention; renal function; statin; uric acid.

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Figures

Figure 1
Figure 1
Time course of percent change (± SD) in estimated glomerular filtration rate (eGFR) and serum uric acid (SUA) levels during the study
See this image and copyright information in PMC

References

    1. Chronic Kidney Disease (CKD) National Kidney Foundation. Available at: http://www.kidney.org/kidneyDisease/ckd/index.cfm. Accessed August 6, 2011.
    1. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39(suppl 1):S1–266. - PubMed
    1. Coresh J, Selvin E, Stevens LA, et al. Prevalence of chronic kidney disease in the United States. JAMA. 2007;298:2038–47. - PubMed
    1. Levey AS, Coresh J, Balk E, et al. National Kidney Foundation. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med. 2003;139:137–47. - PubMed
    1. Coresh J, Astor BC, Greene T, Eknoyan G, Levey AS. Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey. Am J Kidney Dis. 2003;41:1–12. - PubMed