A JEYARUBAN1,2,3, WE HOY1,2, A CAMERON1,2, HG HEALY1,2,3, J ZHANG1,2, A MALLETT1,2,3
1CKD.QLD and NHMRC CKD.CRE, Brisbane, Australia, 2Faculty of Medicine, The University of Queensland, Herston, Australia, 3Kidney Health Service, Royal Brisbane and Women’s Hospital, Herston, Australia
Aim: To identify whether the type of intervention for ischaemic heart disease (IHD) impacts on mortality or further renal deterioration.
Background: The associations of chronic kidney disease (CKD) and IHD are well known. Clinically, because of the use of intra-arterial contrast media, coronary angiograms are sometimes not performed to avoid further deterioration in kidney function amongst CKD patients.
Method: A retrospective cohort study involved 144 RBWH patients with a diagnosis of IHD enrolled in the CKD.QLD registry from January 2011 to August 2017 with a minimum of 2 years follow up. 59 patients had medical management (MED) and 85 patients had interventions (INT i.e. PCI or CABG) for IHD. Comorbidities, mortality and delta eGFR (CKD-EPI) were analysed.
Results: Patients in the MED group were older (77.5 vs 67.4years; p<0.05) with worse baseline renal function (eGFR:33mL/min/1.73m² vs 40mL/min/1.73m²; p=0.02) and higher serum urate level (0.48 vs 0.45mmol/L; p=0.23). The INT group had lower prevalence of gout (44% vs 56%; p=0.69), diabetes (42% vs 58%; p=0.719), dyslipidaemia (38% vs 62%; p=0.29), cerebrovascular disease (48% vs 52%; p=0.63), peripheral vascular disease (45% vs 55%; p=0.34) and hypertension (44% vs 56%; p=0.06).Kaplan-Meier analysis revealed a significant decrease in mean survival of MED compared to INT patients (1,742.3 days (90.7) vs 2,362.3(80.3); p<0.05). Post adjustment for age and above comorbidities, MED and higher age were associated with significantly higher mortality (p<0.05). However, the patients in the MED and INT groups had no significant difference in delta eGFR (CKD-EPI; p=0.4).
Conclusion: In this small cohort study, intervention for IHD was associated with increased survival with no change in renal disease progression in comparison to medically managed patients.
Andrew Jeyaruban is currently a medical registrar with a keen interest in renal medicine. He graduated from James Cook University with Honours in 2014. Andrew then completed his residency at the Royal Brisbane and Women’s Hospital Brisbane, Australia. He is currently a basic physician trainee at the Liverpool Hospital, Sydney.