Dialysis Initiation in Patients With Chronic Coronary Disease and Advanced Chronic Kidney Disease in ISCHEMIA‐CKD
Background In participants with concomitant chronic coronary disease and advanced chronic kidney disease (CKD), the effect of treatment strategies on the timing of dialysis initiation is not well characterized. Methods and Results In ISCHEMIA‐CKD (International Study of Comparative Health Effectiven...
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| Format: | Article |
| Language: | English |
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Wiley
2022-03-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.121.022003 |
| _version_ | 1827978576772726784 |
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| author | Carlo Briguori Roy O. Mathew Zhen Huang Kreton Mavromatis LaTonya J. Hickson Wei Ling Lau Anoop Mathew Sandeep Mahajan David C. Wheeler Kathleen J. Claes Gang Chen Fernando E. B. Nolasco Gregg W. Stone Jerome L. Fleg Mandeep S. Sidhu Frank W. Rockhold Glenn M. Chertow Judith S. Hochman David J. Maron Sripal Bangalore |
| author_facet | Carlo Briguori Roy O. Mathew Zhen Huang Kreton Mavromatis LaTonya J. Hickson Wei Ling Lau Anoop Mathew Sandeep Mahajan David C. Wheeler Kathleen J. Claes Gang Chen Fernando E. B. Nolasco Gregg W. Stone Jerome L. Fleg Mandeep S. Sidhu Frank W. Rockhold Glenn M. Chertow Judith S. Hochman David J. Maron Sripal Bangalore |
| author_sort | Carlo Briguori |
| collection | DOAJ |
| description | Background In participants with concomitant chronic coronary disease and advanced chronic kidney disease (CKD), the effect of treatment strategies on the timing of dialysis initiation is not well characterized. Methods and Results In ISCHEMIA‐CKD (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches–Chronic Kidney Disease), 777 participants with advanced CKD and moderate or severe ischemia were randomized to either an initial invasive or conservative management strategy. Herein, we compare the proportion of randomized participants with non–dialysis‐requiring CKD at baseline (n=362) who initiated dialysis and compare the time to dialysis initiation between invasive versus conservative management arms. Using multivariable Cox regression analysis, we also sought to identify the effect of invasive versus conservative chronic coronary disease management strategies on dialysis initiation. At a median follow‐up of 23 months (25th–75th interquartile range, 14–32 months), dialysis was initiated in 18.9% of participants (36/190) in the invasive strategy and 16.9% of participants (29/172) in the conservative strategy (P=0.22). The median time to dialysis initiation was 6.0 months (interquartile range, 3.0–16.0 months) in the invasive group and 18.2 months (interquartile range, 12.2–25.0 months) in the conservative group (P=0.004), with no difference in procedural acute kidney injury rates between the groups (7.8% versus 5.4%; P=0.26). Baseline clinical factors associated with earlier dialysis initiation were lower baseline estimated glomerular filtration rate (hazard ratio [HR] associated with 5‐unit decrease, 2.08 [95% CI, 1.72–2.56]; P<0.001), diabetes (HR, 2.30 [95% CI, 1.28–4.13]; P=0.005), hypertension (HR, 7.97 [95% CI, 1.09–58.21]; P=0.041), and Hispanic ethnicity (HR, 2.34 [95% CI, 1.22–4.47]; P=0.010). Conclusions In participants with non–dialysis‐requiring CKD in ISCHEMIA‐CKD, randomization to an invasive chronic coronary disease management strategy (relative to a conservative chronic coronary disease management strategy) is associated with an accelerated time to initiation of maintenance dialysis for kidney failure. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01985360. |
| first_indexed | 2024-04-09T21:23:02Z |
| format | Article |
| id | doaj.art-bcb572cf437e47e9a6b5f8579a2695fb |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-09T21:23:02Z |
| publishDate | 2022-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-bcb572cf437e47e9a6b5f8579a2695fb2023-03-28T04:20:50ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802022-03-0111610.1161/JAHA.121.022003Dialysis Initiation in Patients With Chronic Coronary Disease and Advanced Chronic Kidney Disease in ISCHEMIA‐CKDCarlo Briguori0Roy O. Mathew1Zhen Huang2Kreton Mavromatis3LaTonya J. Hickson4Wei Ling Lau5Anoop Mathew6Sandeep Mahajan7David C. Wheeler8Kathleen J. Claes9Gang Chen10Fernando E. B. Nolasco11Gregg W. Stone12Jerome L. Fleg13Mandeep S. Sidhu14Frank W. Rockhold15Glenn M. Chertow16Judith S. Hochman17David J. Maron18Sripal Bangalore19Mediterranea Cardiocentro Naples ItalyLoma Linda VA Health Care System Loma Linda CADuke Clinical Research Institute Duke University Medical Center Durham NCAtlanta VA Healthcare System and Emory University School of Medicine Atlanta GAMayo Clinic Jacksonville FLDivision of Nephrology Department of Medicine University of California‐Irvine Irvine CAUniversity of Alberta Hospital Edmonton Alberta CanadaAll India Institute of Medical Sciences Delhi IndiaUniversity College London London United KingdomDepartment of Nephrology University Hospitals Leuven Leuven BelgiumPeking Union Medical College Hospital Beijing ChinaCentro Hospitalar Lisboa Central Lisbon PortugalIcahn School of Medicine at Mount Sinai New York NYNational Heart, Lung, and Blood Institute Bethesda MDAlbany Medical College Albany NYDuke Clinical Research Institute Duke University Medical Center Durham NCStanford University School of Medicine Stanford CANYU Grossman School of Medicine New York NYStanford University School of Medicine Stanford CANYU Grossman School of Medicine New York NYBackground In participants with concomitant chronic coronary disease and advanced chronic kidney disease (CKD), the effect of treatment strategies on the timing of dialysis initiation is not well characterized. Methods and Results In ISCHEMIA‐CKD (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches–Chronic Kidney Disease), 777 participants with advanced CKD and moderate or severe ischemia were randomized to either an initial invasive or conservative management strategy. Herein, we compare the proportion of randomized participants with non–dialysis‐requiring CKD at baseline (n=362) who initiated dialysis and compare the time to dialysis initiation between invasive versus conservative management arms. Using multivariable Cox regression analysis, we also sought to identify the effect of invasive versus conservative chronic coronary disease management strategies on dialysis initiation. At a median follow‐up of 23 months (25th–75th interquartile range, 14–32 months), dialysis was initiated in 18.9% of participants (36/190) in the invasive strategy and 16.9% of participants (29/172) in the conservative strategy (P=0.22). The median time to dialysis initiation was 6.0 months (interquartile range, 3.0–16.0 months) in the invasive group and 18.2 months (interquartile range, 12.2–25.0 months) in the conservative group (P=0.004), with no difference in procedural acute kidney injury rates between the groups (7.8% versus 5.4%; P=0.26). Baseline clinical factors associated with earlier dialysis initiation were lower baseline estimated glomerular filtration rate (hazard ratio [HR] associated with 5‐unit decrease, 2.08 [95% CI, 1.72–2.56]; P<0.001), diabetes (HR, 2.30 [95% CI, 1.28–4.13]; P=0.005), hypertension (HR, 7.97 [95% CI, 1.09–58.21]; P=0.041), and Hispanic ethnicity (HR, 2.34 [95% CI, 1.22–4.47]; P=0.010). Conclusions In participants with non–dialysis‐requiring CKD in ISCHEMIA‐CKD, randomization to an invasive chronic coronary disease management strategy (relative to a conservative chronic coronary disease management strategy) is associated with an accelerated time to initiation of maintenance dialysis for kidney failure. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01985360.https://www.ahajournals.org/doi/10.1161/JAHA.121.022003chronic coronary diseasechronic kidney diseasedialysisguideline‐directed medical therapy |
| spellingShingle | Carlo Briguori Roy O. Mathew Zhen Huang Kreton Mavromatis LaTonya J. Hickson Wei Ling Lau Anoop Mathew Sandeep Mahajan David C. Wheeler Kathleen J. Claes Gang Chen Fernando E. B. Nolasco Gregg W. Stone Jerome L. Fleg Mandeep S. Sidhu Frank W. Rockhold Glenn M. Chertow Judith S. Hochman David J. Maron Sripal Bangalore Dialysis Initiation in Patients With Chronic Coronary Disease and Advanced Chronic Kidney Disease in ISCHEMIA‐CKD Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease chronic coronary disease chronic kidney disease dialysis guideline‐directed medical therapy |
| title | Dialysis Initiation in Patients With Chronic Coronary Disease and Advanced Chronic Kidney Disease in ISCHEMIA‐CKD |
| title_full | Dialysis Initiation in Patients With Chronic Coronary Disease and Advanced Chronic Kidney Disease in ISCHEMIA‐CKD |
| title_fullStr | Dialysis Initiation in Patients With Chronic Coronary Disease and Advanced Chronic Kidney Disease in ISCHEMIA‐CKD |
| title_full_unstemmed | Dialysis Initiation in Patients With Chronic Coronary Disease and Advanced Chronic Kidney Disease in ISCHEMIA‐CKD |
| title_short | Dialysis Initiation in Patients With Chronic Coronary Disease and Advanced Chronic Kidney Disease in ISCHEMIA‐CKD |
| title_sort | dialysis initiation in patients with chronic coronary disease and advanced chronic kidney disease in ischemia ckd |
| topic | chronic coronary disease chronic kidney disease dialysis guideline‐directed medical therapy |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.121.022003 |
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