Related Experiment Video

Updated: Jun 26, 2026

Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform
07:13

Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform

Published on: April 12, 2021

Hospital performance and differences by kidney function in the use of recommended therapies after non-ST-elevation

Uptal D Patel1, Fang-Shu Ou, E Magnus Ohman

  • 1Division of Nephrology, Duke University Medical Center, Durham, NC, USA. patel080@mc.duke.edu

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
|December 23, 2008
PubMed

Insights

Patients with chronic kidney disease (CKD) and acute coronary syndromes receive less evidence-based therapy. Treatment disparities for CKD patients are more apparent at high-performing hospitals.

Area of Science:

  • Cardiology
  • Nephrology
  • Health Services Research

Background:

  • Chronic kidney disease (CKD) increases cardiac event risk, yet guideline therapies are underused.
  • The impact of hospital performance on CKD patient care for acute coronary syndromes is not well understood.

Purpose of the Study:

  • To investigate the relationship between hospital performance and the use of guideline-recommended therapies in patients with non-ST-segment elevation acute coronary syndromes (NSTE ACSs) and varying degrees of kidney function.
  • To identify potential treatment disparities in NSTE ACS patients with CKD.

Main Methods:

  • An observational cohort study of 81,374 patients with NSTE ACSs treated at 327 US hospitals.
  • Hospital performance was assessed by adherence to American Heart Association guidelines for acute and discharge therapies.
  • Therapy use was stratified by estimated glomerular filtration rate (eGFR) and adjusted for patient and hospital factors.

Main Results:

  • Higher-performing hospitals showed lower therapy prescribing rates for patients with reduced kidney function (lower eGFR).
  • Lower-performing hospitals exhibited prescribing patterns less sensitive to eGFR, maintaining similar rates across kidney function levels.
  • This suggests treatment disparities for CKD patients are more pronounced at top-performing institutions.

Conclusions:

  • Patients with CKD admitted for NSTE ACSs are less likely to receive guideline-recommended treatments.
  • Treatment disparities linked to CKD are most evident in hospitals with higher performance metrics.
  • Further research is needed to address these disparities and improve care for CKD patients with ACS.
Abstract

Related Concept Videos

Acute Kidney Injury V: Interprofessional Care01:20

Acute Kidney Injury V: Interprofessional Care

Acute Kidney Injury (AKI) requires a collaborative healthcare approach to restore renal function and prevent complications. Essential management strategies involve monitoring fluid and electrolyte balance, adjusting medications, initiating dialysis when necessary, and providing nutritional support.Fluid and Electrolyte ManagementFluid Monitoring: Regularly monitoring body weight, central venous pressure, and urine output helps detect fluid imbalances early. Patient intake and output are...
Acute Kidney Injury IV: Diagnostic Studies and Prevention01:30

Acute Kidney Injury IV: Diagnostic Studies and Prevention

Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
Chronic Kidney Disease III: Interprofessional Care01:28

Chronic Kidney Disease III: Interprofessional Care

Chronic kidney disease (CKD) requires collaborative and comprehensive management. CKD progresses through stages and can lead to end-stage kidney disease (ESKD) if untreated. Interprofessional collaboration and patient education are crucial, enabling patients to manage their health and improve their quality of life.Diagnostic approach for chronic kidney diseaseThe diagnosis of CKD primarily focuses on the glomerular filtration rate (GFR), which assesses kidney function by measuring how well...
Acute Coronary Syndrome IV: Interprofessional Care01:28

Acute Coronary Syndrome IV: Interprofessional Care

IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
Acute Kidney Injury VI: Nursing Management01:22

Acute Kidney Injury VI: Nursing Management

Acute Kidney Injury (AKI) results in an inability to maintain fluid, electrolyte, and acid-base balance. Effective nursing management is critical in improving patient outcomes and includes comprehensive patient assessment and targeted interventions.Comprehensive Patient AssessmentA detailed history collection is essential, focusing on any recent infections, nephrotoxic medication use, or chronic conditions such as hypertension and diabetes that may contribute to AKI. During the physical...
Cardiac Catheterization I: Pre-Procedure Overview01:28

Cardiac Catheterization I: Pre-Procedure Overview

Cardiac catheterization is an invasive diagnostic technique used to identify and evaluate structural and functional diseases of the heart and major blood vessels. This technique diagnoses congenital heart disease, coronary artery disease, valvular heart disease, and coronary spasms and assesses ventricular function. It helps guide treatment decisions, including the need for revascularization procedures like percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) and...