Moderate kidney disease associated with cardiovascular events

Chronic kidney disease patients face a greater risk of cardiovascular events such as stent thrombosis after being treated for heart attacks, even if their kidney disease is moderate, according to researchers from Wake Forest University Baptist Medical Center.

Stent thrombosis means that a clot has developed after a stent has been placed in a patient's blocked artery to open up the blood flow. Previous studies had shown that severe kidney disease or kidney failure (stage 5) was a risk factor for stent thrombosis.

However, the Wake Forest Baptist study showed that even people with moderate chronic kidney disease (stage 3 or 4) also face a greater risk of a cardiovascular event, according to lead investigator David C. Sane, M.D., associate professor of cardiology at Wake Forest University School of Medicine.

The study of 956 patients, who were treated at Wake Forest Baptist for a heart attack or acute myocardial infarction and who were followed for a year, was published recently in the American Heart Journal.

Nathan D. Lambert, M.D., one of the Wake Forest Baptist researchers, said, "We thought it was important to look at this because moderate kidney disease is far more prevalent - 16 million people have it - versus the 340,000 people who have been diagnosed with stage 5 or end-stage CKD."

The study also looked at the presence of protein in the urine, common with diabetic patients and often a marker of kidney dysfunction. The presence of both moderate kidney disease and proteinuria predicted a higher rate of cardiovascular events, specifically stent thrombosis.

This study highlights the importance of being aware of the cardiovascular risks to these patients, Lambert said, particularly since stent thrombosis is associated with bad outcomes. Additional cardiac risk factors for many of these patients can be high blood pressure, diabetes, family history, and high cholesterol.

"We need to discuss what we can do differently or better for these patients with moderate kidney disease," Lambert said. "Presumably they might benefit from different therapies. They may need a more potent or longer dose of antiplatelet drugs. This also means more vigilance with the patient who has moderate kidney disease. We want to make sure they are followed closely and are compliant with their medication."

The other Wake Forest Baptist researchers who participated in the study include: Matthew T. Sacrinty, M.P.H., Terry R. Ketch, M.D., Samuel J. Turner, M.D., Renato M. Santos, M.D., Kurt R. Daniel, D.O., Robert J. Applegate, M.D., and Michael A. Kutcher, M.D.