Patients with combination of coronary artery disease and chronic kidney disease in clinical practice: comorbidities and cardiovascular pharmacotherapy

Aim. To define the proportion of comorbid chronic kidney disease (CKD) in the cohort of patients with coronary artery disease (CAD) and to estimate the incidence of comorbidities and required cardiovascular pharmacotherapy on a basis of united data from several medical registries.

Material and methods. We have analyzed the united data from 11 registries of patients with cardiovascular diseases (CVD) created in 6 regions of Russia under the supervision of the National Medical Research Center for Therapy and Preventive Medicine. There are 13089 patients with IHD in those registries including 1419 (10.8%) with CAD and CKD combination (36.6% men, age 73.1±9.4 years), 10649 (81.4%) patients with CAD without CKD (48.9% men, age 68.2±9.4 years). There are 1021 (7.8%) patients without convincing data for presence or absence of CKD. The CAD criterion was registration of this diagnosis in medical documents. The CKD criterion was registration of this diagnosis in medical documents and/or low glomerular filtration rate (<60 ml/min/1.73 m²) revealed at least twice with an interval not less than 3 months.

Results. The incidence of cardiovascular multimorbidity in patients with CAD and CKD combination was bigger than in patients with CAD without CKD (96.0% vs 90.3%; р<0.001). The average number of CVD (2.85±0.8 vs 2.54±0.83; p<0.01) was also bigger, including the subgroups with history of myocardial infarction (MI (2.96±0.8 vs 2.6±0.86; р<0.01)) and acute cerebrovascular accident (ACVA (2.96±0.8 и 2.6±0.86; р<0.01)), with diabetes (2.95±0.75 vs 2.66±0.8; р<0.01). It was no significant difference of the incidence of required cardiovascular pharmacotherapy in cases of CAD with and without CKD (58.4% vs 57.6%; р=0.15). This value in patients with CAD and CKD combination was bigger if to compare cases of presence and absence of history of MI (65.4% vs 52.7%; р<0.0001), of ACVA (60.1% vs 57.5%; р<0.0001), but was lower in cases with diabetes mellitus (55.9%) than without diabetes mellitus (59.9%); р=0.0005.

Conclusion. The pooled data of 11 registries of patients with CAD demonstrated 10.8% rate of the combination with CKD. The incidence of cardiovascular multimorbidity, average number of CVD in patients with CAD and CKD combination were significantly bigger in cases of diabetes and history of MI and ACVA. The incidence of required cardiovascular pharmacotherapy accordingly the main indications in patients with CAD and CKD combination was insufficient (58%) and was some bigger in subgroups with history of MI and ACVA but lower in presence of diabetes (55.9%). In patients with CAD and CKD combination, especially against the background of diabetes mellitus, it is necessary to increase the frequency of prognostically significant cardiovascular pharmacotherapy in clinical practice.

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