Managing cardiovascular risk factors in patients with chronic kidney disease: pharmacological and non-pharmacological interventions in the Copenhagen CKD Cohort.
Clin Kidney J
; 17(7): sfae158, 2024 Jul.
Article
in En
| MEDLINE
| ID: mdl-38979108
ABSTRACT
Background:
Although cardiovascular morbidity and mortality are substantial in patients with chronic kidney disease (CKD), guideline-directed treatment of cardiovascular risk factors remains a challenge.Methods:
Observational, cross-sectional study including patients aged 30-75 years with CKD stage 1-5 without kidney replacement therapy from a tertiary hospital outpatient clinic. Data were obtained through patient interview, clinical examination, biochemical work-up, and evaluation of medical records and prescription redemptions. Guideline-directed treatment was evaluated as pharmacologicalinterventions:
antihypertensive and lipid-lowering therapy including adverse effects and adherence estimated as medication possession ratio (MPR); and non-pharmacologicalinterventions:
smoking status, alcohol consumption, body mass index (BMI), and physical activity.Results:
The cohort comprised 741 patients, mean age 58 years, 61.4% male, 50.6% CKD stage 3, 61.0% office blood pressure ≤140/90 mmHg. Antihypertensives were prescribed to 87.0%, median number of medications 2 (IQR 1;3), 70.1% received renin-angiotensin system inhibition, 25.9% reported adverse effects. Non-adherence (MPR < 80%) was present in 23.4% and associated with elevated blood pressure (OR 1.53 (95% CI 1.03;2.27)) and increased urinary albumin excretion, P < 0.001. Lipid-lowering treatment was prescribed to 54.0% of eligible patients, 11.1% reported adverse effects, and 28.5% were non-adherent, which was associated with higher LDL cholesterol, P = 0.036. Overall, 19.2% were current smokers, 16.7% overconsumed alcohol according to Danish health authority recommendations 69.3% had BMI ≥ 25 kg/m2, and 38.3% were physically active <4 hours/week. Among patients prescribed antihypertensives, 51.9% reported having received advice on non-pharmacological interventions.Conclusions:
Improved management of cardiovascular risk in patients with CKD entails intensified medical treatment and increased focus on patient adherence and non-pharmacological interventions.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Language:
En
Journal:
Clin Kidney J
Year:
2024
Document type:
Article
Affiliation country:
Denmark
Country of publication:
United kingdom