Cargando…

Cardiovascular Drug Use After Acute Kidney Injury Among Hospitalized Patients With a History of Myocardial Infarction

INTRODUCTION: Patients who survive acute kidney injury (AKI) may receive fewer cardioprotective drugs. Our objective was to measure the difference in time to dispensing of evidence-based cardiovascular drugs in patients with a history of myocardial infarction (MI) with and without AKI. METHODS: This...

Descripción completa

Detalles Bibliográficos
Autores principales: Meraz-Muñoz, Alejandro Y., Jeyakumar, Nivethika, Luo, Bin, Beaubien-Souligny, William, Chanchlani, Rahul, Clark, Edward G., Harel, Ziv, Kitchlu, Abhijat, Neyra, Javier A., Zappitelli, Michael, Chertow, Glenn M., Garg, Amit X., Wald, Ron, Silver, Samuel A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9939314/
https://www.ncbi.nlm.nih.gov/pubmed/36815105
http://dx.doi.org/10.1016/j.ekir.2022.10.027
_version_ 1784890819739648000
author Meraz-Muñoz, Alejandro Y.
Jeyakumar, Nivethika
Luo, Bin
Beaubien-Souligny, William
Chanchlani, Rahul
Clark, Edward G.
Harel, Ziv
Kitchlu, Abhijat
Neyra, Javier A.
Zappitelli, Michael
Chertow, Glenn M.
Garg, Amit X.
Wald, Ron
Silver, Samuel A.
author_facet Meraz-Muñoz, Alejandro Y.
Jeyakumar, Nivethika
Luo, Bin
Beaubien-Souligny, William
Chanchlani, Rahul
Clark, Edward G.
Harel, Ziv
Kitchlu, Abhijat
Neyra, Javier A.
Zappitelli, Michael
Chertow, Glenn M.
Garg, Amit X.
Wald, Ron
Silver, Samuel A.
author_sort Meraz-Muñoz, Alejandro Y.
collection PubMed
description INTRODUCTION: Patients who survive acute kidney injury (AKI) may receive fewer cardioprotective drugs. Our objective was to measure the difference in time to dispensing of evidence-based cardiovascular drugs in patients with a history of myocardial infarction (MI) with and without AKI. METHODS: This was a population-based cohort study of patients 66 years of age and older with a history of MI who survived a hospitalization complicated with AKI, propensity-score matched to patients without AKI. The primary outcome was time to outpatient dispensing of an angiotensin-converting enzyme inhibitor (ACEi)/angiotensin II receptor blocker (ARB), statin, or β-blocker within 1 year of hospital discharge. RESULTS: We identified 28,871 patients with AKI, of whom 21,452 were matched 1:1 to patients without AKI. In the matched cohort, mean age was 80 years, 40% were female, and 34% had an MI during the index hospitalization. AKI was associated with less frequent dispensing of all 3 cardiovascular drug classes within 1 year of hospital discharge (subdistribution hazard ratio [sHR], 0.93; 95% confidence interval [CI], 0.91–0.95). This association was most pronounced in patients with stage 2 (sHR, 0.81; 95% CI, 0.75–0.88) and stage 3 (sHR, 0.71; 95% CI, 0.64–0.79) AKI. We observed less frequent dispensing of statins in patients with stage 2 (sHR, 0.87; 95% CI, 0.81–0.92) and stage 3 (sHR, 0.85; 95% CI, 0.78–0.93) AKI and less frequent dispensing of β-blockers in patients with stage 3 AKI (sHR, 0.86; 95% CI, 0.79–0.94). CONCLUSION: In patients with a history of MI, survivors of AKI were less likely to receive prescriptions for ACEi/ARB, statins, or β-blockers within 1 year of hospital discharge. This association was most pronounced in patients with stages 2 and 3 AKI.
format Online
Article
Text
id pubmed-9939314
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Elsevier
record_format MEDLINE/PubMed
spelling pubmed-99393142023-02-21 Cardiovascular Drug Use After Acute Kidney Injury Among Hospitalized Patients With a History of Myocardial Infarction Meraz-Muñoz, Alejandro Y. Jeyakumar, Nivethika Luo, Bin Beaubien-Souligny, William Chanchlani, Rahul Clark, Edward G. Harel, Ziv Kitchlu, Abhijat Neyra, Javier A. Zappitelli, Michael Chertow, Glenn M. Garg, Amit X. Wald, Ron Silver, Samuel A. Kidney Int Rep Clinical Research INTRODUCTION: Patients who survive acute kidney injury (AKI) may receive fewer cardioprotective drugs. Our objective was to measure the difference in time to dispensing of evidence-based cardiovascular drugs in patients with a history of myocardial infarction (MI) with and without AKI. METHODS: This was a population-based cohort study of patients 66 years of age and older with a history of MI who survived a hospitalization complicated with AKI, propensity-score matched to patients without AKI. The primary outcome was time to outpatient dispensing of an angiotensin-converting enzyme inhibitor (ACEi)/angiotensin II receptor blocker (ARB), statin, or β-blocker within 1 year of hospital discharge. RESULTS: We identified 28,871 patients with AKI, of whom 21,452 were matched 1:1 to patients without AKI. In the matched cohort, mean age was 80 years, 40% were female, and 34% had an MI during the index hospitalization. AKI was associated with less frequent dispensing of all 3 cardiovascular drug classes within 1 year of hospital discharge (subdistribution hazard ratio [sHR], 0.93; 95% confidence interval [CI], 0.91–0.95). This association was most pronounced in patients with stage 2 (sHR, 0.81; 95% CI, 0.75–0.88) and stage 3 (sHR, 0.71; 95% CI, 0.64–0.79) AKI. We observed less frequent dispensing of statins in patients with stage 2 (sHR, 0.87; 95% CI, 0.81–0.92) and stage 3 (sHR, 0.85; 95% CI, 0.78–0.93) AKI and less frequent dispensing of β-blockers in patients with stage 3 AKI (sHR, 0.86; 95% CI, 0.79–0.94). CONCLUSION: In patients with a history of MI, survivors of AKI were less likely to receive prescriptions for ACEi/ARB, statins, or β-blockers within 1 year of hospital discharge. This association was most pronounced in patients with stages 2 and 3 AKI. Elsevier 2022-11-02 /pmc/articles/PMC9939314/ /pubmed/36815105 http://dx.doi.org/10.1016/j.ekir.2022.10.027 Text en © 2022 Published by Elsevier Inc. on behalf of the International Society of Nephrology. https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Clinical Research
Meraz-Muñoz, Alejandro Y.
Jeyakumar, Nivethika
Luo, Bin
Beaubien-Souligny, William
Chanchlani, Rahul
Clark, Edward G.
Harel, Ziv
Kitchlu, Abhijat
Neyra, Javier A.
Zappitelli, Michael
Chertow, Glenn M.
Garg, Amit X.
Wald, Ron
Silver, Samuel A.
Cardiovascular Drug Use After Acute Kidney Injury Among Hospitalized Patients With a History of Myocardial Infarction
title Cardiovascular Drug Use After Acute Kidney Injury Among Hospitalized Patients With a History of Myocardial Infarction
title_full Cardiovascular Drug Use After Acute Kidney Injury Among Hospitalized Patients With a History of Myocardial Infarction
title_fullStr Cardiovascular Drug Use After Acute Kidney Injury Among Hospitalized Patients With a History of Myocardial Infarction
title_full_unstemmed Cardiovascular Drug Use After Acute Kidney Injury Among Hospitalized Patients With a History of Myocardial Infarction
title_short Cardiovascular Drug Use After Acute Kidney Injury Among Hospitalized Patients With a History of Myocardial Infarction
title_sort cardiovascular drug use after acute kidney injury among hospitalized patients with a history of myocardial infarction
topic Clinical Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9939314/
https://www.ncbi.nlm.nih.gov/pubmed/36815105
http://dx.doi.org/10.1016/j.ekir.2022.10.027
work_keys_str_mv AT merazmunozalejandroy cardiovasculardruguseafteracutekidneyinjuryamonghospitalizedpatientswithahistoryofmyocardialinfarction
AT jeyakumarnivethika cardiovasculardruguseafteracutekidneyinjuryamonghospitalizedpatientswithahistoryofmyocardialinfarction
AT luobin cardiovasculardruguseafteracutekidneyinjuryamonghospitalizedpatientswithahistoryofmyocardialinfarction
AT beaubiensoulignywilliam cardiovasculardruguseafteracutekidneyinjuryamonghospitalizedpatientswithahistoryofmyocardialinfarction
AT chanchlanirahul cardiovasculardruguseafteracutekidneyinjuryamonghospitalizedpatientswithahistoryofmyocardialinfarction
AT clarkedwardg cardiovasculardruguseafteracutekidneyinjuryamonghospitalizedpatientswithahistoryofmyocardialinfarction
AT harelziv cardiovasculardruguseafteracutekidneyinjuryamonghospitalizedpatientswithahistoryofmyocardialinfarction
AT kitchluabhijat cardiovasculardruguseafteracutekidneyinjuryamonghospitalizedpatientswithahistoryofmyocardialinfarction
AT neyrajaviera cardiovasculardruguseafteracutekidneyinjuryamonghospitalizedpatientswithahistoryofmyocardialinfarction
AT zappitellimichael cardiovasculardruguseafteracutekidneyinjuryamonghospitalizedpatientswithahistoryofmyocardialinfarction
AT chertowglennm cardiovasculardruguseafteracutekidneyinjuryamonghospitalizedpatientswithahistoryofmyocardialinfarction
AT gargamitx cardiovasculardruguseafteracutekidneyinjuryamonghospitalizedpatientswithahistoryofmyocardialinfarction
AT waldron cardiovasculardruguseafteracutekidneyinjuryamonghospitalizedpatientswithahistoryofmyocardialinfarction
AT silversamuela cardiovasculardruguseafteracutekidneyinjuryamonghospitalizedpatientswithahistoryofmyocardialinfarction