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Prescription patterns of pharmacological agents for left ventricular systolic dysfunction among hemodialysis patients

Patrick Roy1, Josée Bouchard, Robert Amyot

  • 1Nephrology Division, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Québec, Canada.

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
|September 26, 2006
PubMed

Insights

Few patients with end-stage renal disease and LV systolic dysfunction receive guideline-recommended ACE inhibitors and beta-blockers. Nephrologists cite adverse reactions as the primary barrier to prescribing these essential cardiac medications.

Area of Science:

  • Cardiology
  • Nephrology
  • Pharmacology

Background:

  • Left ventricular (LV) systolic dysfunction management guidelines recommend ACE inhibitors and beta-blockers.
  • These medications may be underused in patients with end-stage renal disease (ESRD).
  • Limited data exist on medication use and barriers in dialysis patients.

Purpose of the Study:

  • To describe the utilization of ACE inhibitors and beta-blockers in hemodialysis patients.
  • To investigate the barriers to prescribing these cardiac medications in ESRD patients.

Main Methods:

  • Prospective study of 420 hemodialysis patients.
  • Echocardiograms used to diagnose LV systolic dysfunction.
  • Cardiac medication use recorded; nephrologist questionnaires administered to identify prescribing barriers.

Main Results:

  • 11% of patients had LV systolic dysfunction (ejection fraction ≤40%).
  • Beta-blockers used in 72%, ACE inhibitors in 36%; only 25.5% received both.
  • Nephrologists cited "adverse reactions" (88%) as the main reason for non-prescription.

Conclusions:

  • Appropriate treatment rates for LV systolic dysfunction in ESRD patients are low (25.5%).
  • Concerns about adverse reactions are the primary barrier for nephrologists not prescribing ACE inhibitors and beta-blockers.
  • Further research is needed to address these prescribing barriers and improve patient outcomes.
Abstract

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