Cardiac risk factors and the use of cardioprotective medications in patients with chronic renal insufficiency

Cardiovascular disease (CVD) is a major cause of morbidity and mortality am ong patients with chronic renal insufficiency (CRI). beta -Adrenergic block ers, acetylsalicylic acid (ASA), angiotensin-converting enzyme (ACE) inhibi tors, and 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (stati ns) all reduce CVD mortality, but little is known about the extent to which these medications are used in patients with CRI. This study, a prospective cross-sectional study of consecutive patients seen by nephrologists in fou r Canadian centers for follow-up of progressive CRI in 1999, was performed to investigate the prevalence of coronary risk factors and use of cardiopro tective medications among patients with CRI. Patients had creatinine cleara nces of 75 mL/min or less but were not on dialysis therapy. Three hundred f our consecutive patients meeting the inclusion criteria were enrolled. Mean age was 60.8 +/- 15.7 years, mean creatinine clearance was 30.3 +/- 18 mL/ min, and the case mix of kidney diseases was similar to that in the Canadia n Organ Replacement Registry data. One hundred seventeen of 304 patients (3 8.5%) had a history of previous CVD, and the prevalence of CVD was greater in patients with more severe CRI. Two hundred forty-three patients (79.9%) had a history of hypertension, 132 patients (43.4%) had hyperlipidemia, 114 patients (37.5%) had diabetes mellitus, and 71 patients (27.3%) were smoke rs. Thirty-five percent of the patients with CVD had blood pressures greate r than 140/90 mm Hg; 103 patients (33.9%) were administered beta -blockers; 196 patients (64.5%), ACE inhibitors or angiotensin-receptor blockers; 83 patients (27.3%), ASA; and 56 patients (18.4%), statins. Patients with diab etes were not more likely than those without diabetes to be prescribed card ioprotective medications. CVD is common in the predialysis population, and its prevalence increases with more severe kidney failure. Despite this, the use of cardioprotective medications is relatively low, end many patients h ad suboptimal blood pressure control. Given the high burden of disease in t hese patients, beta -blockers and ACE inhibitors should be used to control hypertension and/or for cardioprotection, and the increased use of ASA and statins should be considered. (C) 2001 by the National Kidney Foundation.