Invasive Cardiac Management Accelerate Initiation of Dialysis in CKD patients

In patients with concomitant chronic coronary disease and advanced chronic kidney disease (CKD), the effect of treatment strategies on the timing of dialysis initiation is not well characterized. Therefore, Dr Carlo Briguori and his team conducted a study to examine the incidence and timing of dialysis initiation among those participants not on dialysis at baseline according to the randomized CCD management strategy.

The ISCHEMIA‐CKD (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches–Chronic Kidney Disease) already established that invasive coronary heart disease (CHD) management does not reduce the risk for death or nonfatal myocardial infarction compared with conservative management. In this present study, the researchers conducted a post-hoc analysis of data from 362 participants in the ISCHEMIA-CKD. They compared the proportion of randomized non-dialysis requiring patients with CKD at baseline (n=362) who initiated dialysis and further compared the time to dialysis initiation between invasive versus conservative management arms. They used multivariable Cox regression analysis to assess the effect of invasive versus conservative chronic coronary disease management strategies on dialysis initiation.

Key findings of the study:

• Upon median follow-up of 23 months, the researchers observed that dialysis was initiated in 18.9% of participants in the invasive strategy arm and 16.9% of participants in the conservative strategy group.
• They found that the median time to dialysis initiation was 6.0 months in the invasive group and 18.2 months in the conservative group, with no difference in procedural acute kidney injury rates between the groups (7.8% versus 5.4%).
• They also noted other predictors of earlier dialysis initiation such as:

♦ Lower baseline estimated glomerular filtration rate: HR with 5‐unit decrease, 2.07,

♦ Diabetes: HR, 2.29.

♦ Hypertension: HR, 7.83.

♦ Hispanic ethnicity: HR, 2.30.

The authors concluded, "In participants with non–dialysis‐requiring CKD in ISCHEMIA‐CKD, randomization to an invasive chronic coronary disease management strategy (relative to a conservative chronic coronary disease management strategy) is associated with an accelerated time to initiation of maintenance dialysis for kidney failure."

For further information:

DOI: https://doi.org/10.1161/JAHA.121.022003

Keywords: chronic coronary disease, dialysis, early initiation, guideline‐directed medical therapy, ISCHEMIA‐CKD, non–dialysis‐requiring CKD, invasive chronic coronary disease management strategy, CCD, CHD, CKD, Journal of American Heart Association, chronic kidney disease.