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Observational Study
. 2014 Jul 22;9(7):e102335.
doi: 10.1371/journal.pone.0102335. eCollection 2014.

Impact of chronic kidney disease on use of evidence-based therapy in stable coronary artery disease: a prospective analysis of 22,272 patients

Paul R Kalra  1 , Xavier García-Moll  2 , José Zamorano  3 , Philip A Kalra  4 , Kim M Fox  5 , Ian Ford  6 , Roberto Ferrari  7 , Jean-Claude Tardif  8 , Michal Tendera  9 , Nicola Greenlaw  6 , Ph Gabriel Steg; CLARIFY Investigators
Collaborators, Affiliations
Observational Study

Impact of chronic kidney disease on use of evidence-based therapy in stable coronary artery disease: a prospective analysis of 22,272 patients

Paul R Kalra et al. PLoS One. .

Abstract

Purpose: To assess the frequency of chronic kidney disease (CKD), define the associated demographics, and evaluate its association with use of evidence-based drug therapy in a contemporary global study of patients with stable coronary artery disease.

Methods: 22,272 patients from the ProspeCtive observational LongitudinAl RegIstry oF patients with stable coronary arterY disease (CLARIFY) were included. Baseline estimated glomerular filtration rate (eGFR) was calculated (CKD-Epidemiology Collaboration formula) and patients categorised according to CKD stage: >89, 60-89, 45-59 and <45 mL/min/1.73 m2.

Results: Mean (SD) age was 63.9±10.4 years, 77.3% were male, 61.8% had a history of myocardial infarction, 71.9% hypertension, 30.4% diabetes and 75.4% dyslipidaemia. Chronic kidney disease (eGFR<60 mL/min/1.73 m2) was seen in 22.1% of the cohort (6.9% with eGFR<45 mL/min/1.73 m2); lower eGFR was associated with increasing age, female sex, cardiovascular risk factors, overt vascular disease, other comorbidities and higher systolic but lower diastolic blood pressure. High use of secondary prevention was seen across all CKD stages (overall 93.4% lipid-lowering drugs, 95.3% antiplatelets, 75.9% beta-blockers). The proportion of patients taking statins was lower in patients with CKD. Antiplatelet use was significantly lower in patients with CKD whereas oral anticoagulant use was higher. Angiotensin-converting enzyme inhibitor use was lower (52.0% overall) and inversely related to declining eGFR, whereas angiotensin-receptor blockers were more frequently prescribed in patients with reduced eGFR.

Conclusions: Chronic kidney disease is common in patients with stable coronary artery disease and is associated with comorbidities. Whilst use of individual evidence-based medications for secondary prevention was high across all CKD categories, there remains an opportunity to improve the proportion who take all three classes of preventive therapies. Angiotensin-converting enzyme inhibitors were used less frequently in lower eGRF categories. Surprisingly the reverse was seen for angiotensin-receptor blockers. Further evaluation is required to fully understand these associations. The CLARIFY (ProspeCtive observational LongitudinAl RegIstry oF patients with stable coronary arterY disease) Registry is registered in the ISRCTN registry of clinical trials with the number ISRCTN43070564. http://www.controlled-trials.com/ISRCTN43070564.

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Conflict of interest statement

Competing Interests: PRK reports research grants from Servier; consultancy fees/honoraria from A Menarini and Servier. Support for travel to meetings from Servier. XG-M reports advisory and conference fees from Servier. JZ reports speaker fees from Servier. IF reports research grants, honoraria for committee membership, and support for conference attendance from Servier. RF reports Speaker's bureau for Servier, Novartis, Merck Serono; research grants from Servier, Boehringer Ingelheim; and advisory board for Servier, Boehringer Ingelheim and Novartis. J-CT reports that his institution received grants and consulting fees from Servier; he also received a consulting fee or honorarium from Servier; support for travel to meetings for the study or other purposes from Servier; and payment for lectures from Servier. MT reports fees, honoraria, and research grants from Amgen, Bayer, and Servier. PGS reports that his institution received grants and consulting fees from Servier; he also received a consulting fee or honorarium from Servier; support for travel to meetings for the study or other purposes from Servier; and payment for lectures from Servier. The authors declare that the affiliations to the funding organization (Servier) and the declarations provided in the competing interests form do not alter our adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Patient flow chart.
Figure 2
Figure 2. Univariate relationship between chronic kidney disease class and use of (A) angiotensin-converting enzyme inhibitors and (B) angiotensin receptor blocker.
Figure 3
Figure 3. The association of use of (A) angiotensin-converting enzyme inhibitors and (B) angiotensin receptor blocker with chronic kidney disease following adjustment for age, body mass index, systolic blood pressure, diastolic blood pressure, gender, heart rate, smoking status, history of heart failure, angina, diabetes and hypertension.
See this image and copyright information in PMC

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