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Observational Study
. 2016 Feb 9;11(2):e0148057.
doi: 10.1371/journal.pone.0148057. eCollection 2016.

Baseline Characteristics and Prescription Patterns of Standard Drugs in Patients with Angiographically Determined Coronary Artery Disease and Renal Failure (CAD-REF Registry)

Holger Reinecke  1 , Günter Breithardt  1 , Christiane Engelbertz  1   2 , Roland E Schmieder  3 , Manfred Fobker  4 , Hans O Pinnschmidt  5 , Boris Schmitz  6 , Philipp Bruland  7 , Karl Wegscheider  5 , Hermann Pavenstädt  2 , Eva Brand  2
Affiliations
Observational Study

Baseline Characteristics and Prescription Patterns of Standard Drugs in Patients with Angiographically Determined Coronary Artery Disease and Renal Failure (CAD-REF Registry)

Holger Reinecke et al. PLoS One. .

Abstract

Background: Chronic kidney disease (CKD) is strongly associated with coronary artery disease (CAD). We established a prospective observational nationwide multicenter registry to evaluate current treatment and outcomes in patients with both CKD and angiographically documented CAD.

Methods: In 32 cardiological centers 3,352 CAD patients with ≥50% stenosis in at least one coronary artery were enrolled and classified according to their estimated glomerular filtration rate and proteinuria into one of five stages of CKD or as a control group.

Results: 2,723 (81.2%) consecutively enrolled patients suffered from CKD. Compared to controls, CKD patients had a higher prevalence of diabetes, hypertension, peripheral artery diseases, heart failure, and valvular heart disease (each p<0.001). Myocardial infarctions (p = 0.02), coronary bypass grafting, valve replacements and pacemaker implantations had been recorded more frequently (each p<0.001). With advanced CKD, the number of diseased coronary vessels and the proportion of patients with reduced left ventricular ejection fraction (LVEF) increased significantly (both p<0.001). Percutaneous coronary interventions were performed less frequently (p<0.001) while coronary bypass grafting was recommended more often (p = 0.04) with advanced CKD. With regard to standard drugs in CAD treatment, prescriptions were higher in our registry than in previous reports, but beta-blockers (p = 0.008), and angiotensin-converting-enzyme inhibitors and/or angiotensin-receptor blockers (p<0.001) were given less often in higher CKD stages. In contrast, in the subgroup of patients with moderately to severely reduced LVEF the prescription rates did not differ between CKD stages. In-hospital mortality increased stepwise with each CKD stage (p = 0.02).

Conclusions: In line with other studies comprising CKD cohorts, patients' morbidity and in-hospital mortality increased with the degree of renal impairment. Although cardiologists' drug prescription rates in CAD-REF were higher than in previous studies, they were still lower especially in advanced CKD stages compared to cohorts treated by nephrologists.

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Conflict of interest statement

Competing Interests: The authors have read the journal's policy and the authors of this manuscript have the following competing interests: Holger Reinecke has received speaker honoraria from Sanofi-Aventis, Daiichi-Sankyo, The Medicine Company, Cordis, and Novartis. He has acted as a consultant for BMS and Pluristem. He took part in the conduction of multicenter trials of BARD, Bayer, BIOTRONIK, and Pluristem. Günter Breithardt has received research grants for his institution from 3M, Sanofi-Aventis, St. Jude, honoraria from Sanofi-Aventis, Boehringer Ingelheim, Boston Scientific, Bayer Health Care, BMS/Pfizer (all of modest degree), and has been on the following advisory boards: Sanofi-Aventis, Boehringer Ingelheim, Boston Scientific, Bayer Health Care, BMS/Pfizer, MSD, Otsuka Pharma. Roland E. Schmieder is a member of the speakers’ bureau; he has received honoraria from AstraZeneca, Berlin Chemie AG, Boehringer Ingelheim, Bristol Myers Squibb, Daiichi Sankyo, Medtronic, Novartis, Servier, Takeda Pharmaceuticals and Terumo. He has acted as a consultant for AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Daiichi Sankyo, Medtronic, Novartis and Servier, and has received grant or research support (awarded to the University Hospital, University Erlangen/Nürnberg) from AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Daiichi Sankyo, Novartis and Medtronic. Karl Wegscheider has received consulting fees/honoraria from Biotronik, Medtronik, Merck, Resmed, Takeda. Hermann Pavenstädt has received speaker honoraria from Novartis and Merck KGaA. Eva Brand has received speaker honoraria from Sanofi-Aventis, Daiichi-Sankyo, and Novartis. All other authors declare that they have no conflicting interests and no financial disclosures with regard to this publication and the presented results. Research grants for the CAD-REF Registry were given by Amgen GmbH, Munich (https://www.amgen.de/), AstraZeneca GmbH, Wedel (http://www.astrazeneca.de/willkommen), Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein (http://www.boehringer-ingelheim.de/), and Sanofi-Aventis Deutschland GmbH, Frankfurt (http://www.sanofi.de/l/de/de/index.jsp). This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Proportions of patients with different degrees of CAD according to their renal function.
P-values form Jonckheere-Terpstra tests.
Fig 2
Fig 2. Proportion of patients (complete cohort) with respective medication prescription by CKD stage and visit (enrollment at hospital versus hospital discharge).
Effects of CKD stage, visit and CKD stage x visit-interactions were tested via logistic regression.
Fig 3
Fig 3. Proportion of patients (subgroup with moderately to severely reduced LVEF, LVEF≤40%) with respective medication prescription by CKD stage and visit (enrollment at hospital versus hospital discharge).
Effects of CKD stage, visit and CKD stage x visit-interactions were tested via logistic regression.
Fig 4
Fig 4. Proportion of patients who died in-hospital according to their renal function.
P-value from Mann-Whitney-U-test testing category “In-hospital death” vs all other categories of variable “discharge status”.
See this image and copyright information in PMC

References

    1. Levey AS, Atkins R, Coresh J, Cohen EP, Collins AJ, Eckardt KU, et al. Chronic kidney disease as a global public health problem: approaches and initiatives—a position statement from Kidney Disease Improving Global Outcomes. Kidney Int. 2007;72:247–259. - PubMed
    1. Eckardt KU, Coresh J, Devuyst O, Johnson RJ, Köttgen A, Levey AS, et al. Evolving importance of kidney disease: from subspecialty to global health burden. Lancet. 2013;382:158–169. 10.1016/S0140-6736(13)60439-0 - DOI - PubMed
    1. Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, et al. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Circulation. 2003;108:2154–2169. - PubMed
    1. Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351:1296–1305. - PubMed
    1. Bello AK, Hemmelgarn B, Lloyd A, James MT, Manns BJ, Klarenbach S, et al. Associations among estimated glomerular filtration rate, proteinuria, and adverse cardiovascular outcomes. Clin J Am Soc Nephrol. 2011;6:1418–1426. 10.2215/CJN.09741110 - DOI - PMC - PubMed

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