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Patterns of cardioprotective medication prescription in incident hemodialysis patients

Manish M Sood1, Marisa Battistella, Charmaine E Lok

  • 1St. Boniface Hospital and the University of Manitoba, Bg007, 409 Tache Avenue, Winnipeg, MB, Canada. msood@sbgh.mb.ca

International Urology and Nephrology
|August 5, 2009
PubMed

Insights

Cardiac medication use in hemodialysis patients with heart dysfunction is common, but only beta-blockers showed a mortality benefit. Practice patterns rely on non-dialysis patient data.

Area of Science:

  • Nephrology
  • Cardiology
  • Pharmacology

Background:

  • Lack of evidence guides cardiac medication use in hemodialysis (HD) patients.
  • Medical decision-making for cardiac therapy in HD patients with left ventricular dysfunction (LVDys) and post-acute coronary syndrome (ACS) is challenging.

Purpose of the Study:

  • To describe cardioprotective medication prescription patterns in incident HD patients.
  • To analyze prescription patterns in HD patients with LVDys and those with a history of ACS.

Main Methods:

  • Retrospective chart review and dialysis database analysis.
  • Inclusion of incident HD patients from January 2002 to December 2004, followed until 2007 or death.
  • Analysis of 272 patients, including 104 with LVDys and 65 with ACS.

Main Results:

  • Patients with severe LVDys were more likely to receive ACE inhibitors, beta-blockers, statins, and clopidogrel.
  • Patients with ACS received higher rates of ACE inhibitors, beta-blockers, short-acting nitrates, statins, clopidogrel, and ASA.
  • LVDys was associated with mortality, while beta-blockers conferred a mortality benefit (OR 0.50). ACE inhibitors, ARBs, statins, and clopidogrel were not statistically significant.

Conclusions:

  • Hemodialysis patients with LVDys and ACS commonly receive cardiac medications, despite limited direct evidence.
  • Beta-blockers are the only cardiac medication associated with improved mortality in this population.
  • Nephrologists' prescribing habits are influenced by extrapolations from non-end-stage renal disease (ESRD) populations.
Abstract

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