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Assessment of Vascular Function in Patients With Chronic Kidney Disease
08:50

Assessment of Vascular Function in Patients With Chronic Kidney Disease

Published on: June 16, 2014

16.3K

Cardiovascular events in patients with deferred lesions and chronic kidney disease

Takehiro Hata1, Hisao Otsuki1, Hiroyuki Arashi2

  • 1Department of Cardiology, Tokyo Women's Medical University, 8-1, Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan.

Heart and Vessels
|July 10, 2023
PubMed

Insights

Patients with chronic kidney disease (CKD) on hemodialysis face higher cardiovascular event risks, even with deferred coronary lesions. Careful management is crucial for these high-risk individuals.

Area of Science:

  • Cardiology
  • Nephrology
  • Clinical Outcomes

Background:

  • Chronic kidney disease (CKD) progression is linked to cardiovascular events.
  • The association between worsening CKD and cardiovascular events in patients with deferred coronary artery lesions remains understudied.
  • Deferred lesions, defined by fractional flow reserve (FFR) > 0.80, are typically managed conservatively.

Purpose of the Study:

  • To investigate the association between different stages of chronic kidney disease (CKD) and cardiovascular events in patients with deferred coronary artery lesions.
  • To compare clinical outcomes among patients with early-stage CKD, advanced CKD, and end-stage renal disease on hemodialysis.

Main Methods:

  • Retrospective study including patients with deferred coronary lesions (FFR > 0.80) treated medically.
  • Patients categorized into three groups: CKD stages 1-2, CKD stages 3-5, and CKD stage 5D (hemodialysis).
  • Primary endpoint: target vessel myocardial infarction, ischemia-driven revascularization, or all-cause death. Outcomes compared using log-rank test and multivariate Cox proportional hazards model.

Main Results:

  • The incidence of the primary endpoint was significantly higher in the hemodialysis group (CKD stage 5D) compared to earlier CKD stages (p < 0.0001).
  • Multivariate analysis confirmed a higher risk of the primary endpoint in hemodialysis patients versus CKD stages 1-2 (HR: 2.14; 95% CI 1.02-4.49; p < 0.01).
  • The incidence rate of deferred lesions increased with CKD severity, notably higher in the hemodialysis group (32.4%).

Conclusions:

  • Patients with chronic kidney disease (CKD) requiring hemodialysis have a significantly elevated risk of major adverse cardiovascular events, even with deferred coronary artery lesions.
  • Conservative management of deferred lesions in hemodialysis patients requires careful consideration due to heightened risks.
  • Further research into risk stratification and management strategies for this vulnerable population is warranted.

Keywords:
Cardiovascular eventChronic kidney diseaseCoronary artery diseaseDeferred lesion

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