More Preventive Care Lowers Cardiovascular Risk in CKD Patients

Among patients with chonic kidney disease (CKD), those receiving more recommended preventive care measures have lower rates of cardiovascular events and death, reports a study in the Journal of the American Society of Nephrology.

The analysis used three-year rolling cohorts of Medicare patients, including approximately 1.2 million patients per year. In year 1, CKD and diabetes status was assessed. Adherence to preventive health-care recommendations (based on Kidney Disease Outcomes Quality Initiative guidelines) was assessed in year 2 and atherosclerotic heart disease outcomes in year 3.

Eighty percent of CKD patients received at least two serum creatinine measurements, but only 11 percent underwent recommended parathyroid hormone testing. Cumulative incidence of any atherosclerotic heart disease event was 11 percent for patients without pre-existing cardiovascular disease and 25 percent for those with prevalent disease.

For most measures, meeting preventive care recommendations was linked to a lower risk of atherosclerotic heart disease outcomes the following year. Undergoing calcium-phosphorus assessment was associated with a 43 percent reduction in risk the following year. For patients undergoing influenza vaccination and two or more A1c measurements, risk decreased by 13 percent. The exception was serum creatinine measurement—patients undergoing two or more tests were at 13 percent higher risk the next year.

The greater the number of preventive measures in patients with CKD, the lower the risk of atherosclerotic heart disease outcomes. In the full study sample, receiving most or all preventive measures would avoid about 75,000 events per year [Snyder JJ, Collins AJ: Association of preventive health care with atherosclerotic heart disease and all-cause mortality in CKD. J Am Soc Nephrol 2009; 20: 1614–1622].