Document Detail

Effect of aggressive risk factor modification on cardiac events and myocardial ischaemia in patients with chronic kidney disease.
MedLine Citation:
PMID:  16606867     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To examine whether aggressive risk factor modification in chronic kidney disease (CKD) can limit the development of new ischaemia or reduce cardiac events. METHODS: Patients with CKD were randomly assigned to either an aggressive risk factor modification strategy (targeted treatment of hypertension, dyslipidaemia, homocysteine, haemoglobin and phosphate) or standard care. An intention to treat analysis was performed on 152 patients who had baseline dobutamine stress echocardiography (DSE), including 107 who had follow-up DSE. Biochemical parameters, cardiac risk factors and investigations (ECG, two-dimensional echocardiography) were recorded at baseline. New ischaemia was classed as new or worsening stress wall motion abnormality between follow-up and baseline DSE. Patients were followed up for the development of new ischaemia or cardiac death, acute coronary syndrome and non-fatal myocardial infarction over 1.8 years. RESULTS: The development of new ischaemia was common but not different between the standard and aggressively treated groups (15 (21%) v 18 (23%), p = 0.8). Independent predictors of new ischaemia were older age, abnormal ECG, higher systolic blood pressure and lower serum high density lipoprotein cholesterol, but not treatment arm. The standard and aggressively treated groups did not differ in cardiac event rate (10% v 13%, p = 0.6) or all-cause mortality (10% v 19%, p = 0.2). In patients with an abnormal baseline DSE (non-diagnostic, scar or ischaemia), the event rate was similar (22% v 20%, p = 0.9). CONCLUSION: Aggressive risk factor modification in CKD does not limit the development of new ischaemia or reduce cardiac events in patients with an abnormal DSE.
D J Rakhit; T H Marwick; K A Armstrong; D W Johnson; R Leano; N M Isbel
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2006-04-10
Journal Detail:
Title:  Heart (British Cardiac Society)     Volume:  92     ISSN:  1468-201X     ISO Abbreviation:  Heart     Publication Date:  2006 Oct 
Date Detail:
Created Date:  2006-09-15     Completed Date:  2006-10-20     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  9602087     Medline TA:  Heart     Country:  England    
Other Details:
Languages:  eng     Pagination:  1402-8     Citation Subset:  AIM; IM    
University of Queensland, Brisbane, Australia.
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MeSH Terms
Coronary Disease / prevention & control
Death, Sudden, Cardiac / prevention & control
Disease-Free Survival
Echocardiography, Stress
Homocysteine / blood
Hypercholesterolemia / prevention & control
Kidney Failure, Chronic / complications*,  therapy
Middle Aged
Myocardial Infarction
Myocardial Ischemia / prevention & control*,  therapy
Recurrence / prevention & control
Regression Analysis
Renal Dialysis
Risk Factors
Reg. No./Substance:

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