Cardiovascular medication use after coronary bypass surgery in patients with renal dysfunction: A National Veterans Administration study[1]

• Published in: Kidney international Vol. 68; no. 2; pp. 826 - 832
• Main Authors: Gibney, Eric M., Casebeer, Adrianne W., Schooley, Lynn M., Cunningham, Francesca, Grover, Frederick L., Bell, Missy R., Mcdonald, Gerald O., Shroyer, A. Laurie, Parikh, Chirag R.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.08.2005; Nature Publishing
• Subjects: Adrenergic beta-Antagonists - therapeutic use; Aged; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Biological and medical sciences; cardiac surgery; Cardiology. Vascular system; cardiovascular disease; Cardiovascular Diseases - complications; Cardiovascular Diseases - drug therapy; Cardiovascular Diseases - surgery; Coronary Artery Bypass; Coronary heart disease; Heart; Humans; Hypolipidemic Agents - therapeutic use; Kidney Failure, Chronic - complications; Medical sciences; Middle Aged; mortality; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Platelet Aggregation Inhibitors - therapeutic use; Postoperative Period; Renal failure; Retrospective Studies; United States; United States Department of Veterans Affairs - statistics & numerical data; United States; mortality; cardiovascular disease; cardiac surgery; Kidney disease; Heart; Human; Nephrology; Urinary system disease; Mortality; Coronary artery; Surgical anastomosis; Cardiovascular disease; Coronary heart disease; Epidemiology; Urology; Treatment; Surgery; Renal failure; Circulatory system; Veteran
• ISSN: 0085-2538; 1523-1755
• DOI: 10.1016/S0085-2538(15)50905-8

Cardiovascular medication use after coronary bypass surgery in patients with renal dysfunction: A national Veterans Administration study. Chronic kidney disease is now recognized as an independent risk factor for cardiovascular events. We sought to determine if cardiovascular medications were utilized less in patients with renal dysfunction following coronary artery bypass grafting (CABG) and if the association of decreased medication use was independent of comorbid conditions. We also examined associations between cardiovascular medication use and mortality at 6 months. Data from the National Veterans Adminstration (VA) Continuous Improvement in Cardiac Surgery Program were merged with the national VA pharmacy database. Prescription rates within 6 months of discharge for CABG were obtained for four classes of medicines: beta blockers, lipid-lowering agents, antiplatelet agents, and angiotensin antagonists. Utilization of medications in patients with estimated glomerular filtration rate (GFR) 60 to 90, 30 to 60, and <30 were compared with the reference group of GFR >90. In a retrospective analysis of 19,411 patients, the frequency of nonprescription increased with declining GFR. Decreased utilization for patients with GFR 30 to 60 and <30 remained highly significant after adjustment for age, race, hypertension, diabetes, and prior myocardial infarction. In patients with more advanced renal dysfunction (GFR <60), cardiovascular medication use for all medication classes was associated with survival at 6 months after adjusting for demographic and clinical variables. Cumulative protection was seen with use of medication from each additional class. In a large VA population undergoing CABG, renal disease is associated with highly significant decreases in utilization of cardiovascular medications. Nonprescription of medications was associated with adverse outcomes in those with renal dysfunction.