Article - July 9, 2008 - MedPage Today

Kidney Disease Marginally Linked to Poor Drug Use After MI

By Judith Groch

BOSTON, July 9 -- Chronic kidney disease patients who have a heart attack, and particularly dialysis patients, wind up underusing cardiovascular medications, a study found.

The reasons were not clear. It was not possible to determine whether a patient received a medication prescription, chose not to fill it, or actually took the drug, the investigators noted.

However, compliance was "suboptimal" for all patients, with and without kidney disease, and, with the exception of dialysis patients, kidney disease did not determine adherence to prescribed medications, Wolfgang C. Winkelmayer, M.D., of Brigham and Women's Hospital here, and colleagues reported online in the Clinical Journal of the American Society of Nephrology.

Furthermore, underuse of cardiovascular medication among patients with kidney disease did not appear responsible for the known increase in mortality after myocardial infarction in patients with reduced kidney function, the investigators said.

To determine whether kidney function affects adherence to recommended medications after an MI, the researchers undertook a retrospective cohort study of 21,500 patients ages 65 or older in New Jersey and Pennsylvania from 1995 through 2004.

Patients were categorized as having end-stage renal disease (2%), chronic kidney disease (17%), or being free of diagnosed kidney disease (81%).

Use of ACE inhibitors or angiotensin receptor blockers and statins was assessed within 30 days of discharge. Good adherence was defined as proportion of days covered >80% during the first year after discharge.

Overall rates of medication use were low for all patients. Within 30 days of discharge, 57.3% filled a prescription for a beta-blocker, 26.7% for a statin, and 44.1% for an ACE inhibitor or angiotensin receptor blocker.

After multivariate adjustment, compared with patients with no kidney disease, those with chronic kidney disease had a 22% lower adjusted use of ACE or angiotensin receptor blocker drugs, but similar rates of beta-blocker and statin use.

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