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Emergency evaluation of chest pain in patients with advanced kidney disease

Peter A McCullough1, Richard M Nowak, Craig Foreback

  • 1Cardiology Section, Department of Basic Science, Truman Medical Center, University of Missouri-Kansas City School of Medicine, 2301 Holmes St, Kansas City, MO 64108, USA. pmc@yahoo.com

Archives of Internal Medicine
|November 20, 2002
PubMed

Insights

Patients with chronic kidney disease presenting with chest discomfort face higher risks of heart attack, heart failure, and death. Early identification and management are crucial for improving outcomes in this vulnerable population.

Area of Science:

  • Cardiology
  • Nephrology
  • Emergency Medicine

Background:

  • Patients with chronic kidney disease (CKD) experience elevated risks of myocardial infarction, heart failure, arrhythmias, and mortality.
  • The study aimed to assess care processes and outcomes for CKD patients presenting with chest discomfort in the emergency department.

Purpose of the Study:

  • To evaluate the association between chronic kidney disease severity and cardiac care processes and outcomes.
  • To determine the impact of renal dysfunction on patients presenting with chest discomfort.

Main Methods:

  • A prospective study enrolled 817 patients evaluated for acute myocardial infarction, including those with renal dysfunction.
  • Patients were stratified by creatinine clearance into quartiles and a dialysis group (n=51).
  • Baseline renal function and 30-day outcomes were analyzed for 808 patients.

Main Results:

  • Patients with advanced CKD (creatinine clearance <47.0 mL/min) or on dialysis had higher rates of diabetes, hypertension, and prior coronary disease.
  • Stress testing rates decreased with worsening renal dysfunction, while revascularization rates remained similar across groups.
  • Advanced CKD patients experienced the highest in-hospital heart failure (36.5%) and 30-day cumulative events including myocardial infarction, heart failure, and death (40.2%).

Conclusions:

  • Chronic kidney disease is a significant predictor of adverse in-hospital and 30-day outcomes.
  • Patients with CKD presenting with chest discomfort require careful evaluation and management.
  • CKD severity influences the risk of major adverse cardiac events and mortality in the emergency department setting.
Abstract

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