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

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

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.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Cardiovascular Agents / therapeutic use
  • Coronary Artery Disease / drug therapy*
  • Evidence-Based Medicine
  • Female
  • Glomerular Filtration Rate
  • Humans
  • Male
  • Middle Aged
  • Platelet Aggregation Inhibitors / therapeutic use
  • Prospective Studies
  • Renal Insufficiency, Chronic / physiopathology*
  • Treatment Outcome

Substances

  • Angiotensin-Converting Enzyme Inhibitors
  • Cardiovascular Agents
  • Platelet Aggregation Inhibitors

Associated data

  • ISRCTN/ISRCTN43070564

Grant support

The study was designed and conducted by the investigators and funded via research grants from Servier, France, including a grant to the academic statistical centre. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials. The sponsor had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript, but did assist with the set up and management of the study in each country. Sophie Rushton-Smith provided editorial assistance, limited to editing, checking content and language, formatting, and referencing, and was compensated by the sponsor. The CLARIFY registry enforces a no ghost-writing policy. This manuscript was written by the authors, who take full responsibility for its content.