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Abstract: PO2117

Optimal Medical Therapy Attainment by Dialysis Status in the ISCHEMIA-CKD Trial

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Mathew, Roy O., William Jennings Bryan Dorn VA Medical Center Mental Health Department, Columbia, South Carolina, United States
  • Maron, David J., Stanford University Department of Medicine, Stanford, California, United States
  • Anthopolos, Rebecca, New York University School of Medicine, New York, New York, United States
  • Fleg, Jerome L., National Heart Lung and Blood Institute, Bethesda, Maryland, United States
  • O'Brien, Sean, Duke Cinical Research Institute, Durham, North Carolina, United States
  • Rockhold, Frank W., Duke Cinical Research Institute, Durham, North Carolina, United States
  • Briguori, Carlo, Mediterranea Cardiocentro, Naples, Campania, Italy
  • Roik, Marek, Department of Internal Medicine, Infant Jesus Teaching Hospital, Medical University of Warsaw, Warsaw, Poland
  • Mazurek, Tomasz, Warszawski Uniwersytet Medyczny, Warszawa, Poland
  • Demkow, Marcin, National Institute of Cardiology - II Cardiology Clinic, Mazovian, Poland
  • Malecki, Robert, National Institute of Cardiology - II Cardiology Clinic, Mazovian, Poland
  • Kaul, Upendra, Batra Hospital and Medical Research Centre, New Delhi, Delhi, India
  • Miglinas, Marius, Vilniaus Universiteto ligonines Santariskiu klinikos, Vilnius, Lithuania
  • Wald, Ron, St Michael's Hospital, Toronto, Ontario, Canada
  • Charytan, David M., New York University School of Medicine, New York, New York, United States
  • Sidhu, Mandeep S., Albany Medical College, Albany, New York, United States
  • Hochman, Judith, New York University School of Medicine, New York, New York, United States
  • Bangalore, Sripal, New York University School of Medicine, New York, New York, United States

Group or Team Name

  • ISCHEMIA-CKD Research
Background

The efficacy of an aggressive multiple risk factor intervention approach – optimal medical therapy (OMT) – to reduce major adverse cardiovascular events in patients with CKD has not been tested. Objective: to examine OMT goal attainment in patients with CKD on dialysis (CKD-D) and non-dialysis CKD (CKD-ND) in the ISCHEMIA-CKD trial.

Methods

OMT was recommended to all participants in ISCHEMIA-CKD. Longitudinal trajectories of individual OMT components (smoking cessation, systolic blood pressure (SBP) <140 mmHg, low density lipoprotein (LDL) cholesterol <70 mg/dL, high-intensity statin use, and aspirin use) were modeled over study follow-up. Covariate-adjusted percentage point difference in each OMT goal achieved at 24 months between CKD-D and CKD-ND groups (% difference [95% credible interval (CrI)]) was estimated.

Results

There were 415 CKD-D and 362 CKD-ND patients at baseline. CKD-D were younger (61 v 67 yrs, p<0.001) and less often diabetic (53% v 62%, p=0.023). CKD-D patients were 7.9 % (0.7%, 14.8%) more likely than CKD-ND to attain the SBP goal at 24 months (Figure). CKD-D patients were 22.7% (-33.3%, -11.4%) less likely to receive high-intensity statins. There was a steady and similar increase in proportional achievement of OMT during follow up.

Conclusion

OMT improved over time in advanced CKD-ND and CKD-D. CKD-D achieved the SBP goal more than CKD-ND, yet CKD-D were less likely to be treated with high-intensity statin. Future studies should explore systemic and patient-related barriers to attainment of OMT in this high-risk cohort.