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IMproving the imPlemEntation of cuRrent guidelines for the mAnagement of major coronary hearT disease rIsk factors by multifactorial interVEntion. The IMPERATIVE renal analysis.

TitleIMproving the imPlemEntation of cuRrent guidelines for the mAnagement of major coronary hearT disease rIsk factors by multifactorial interVEntion. The IMPERATIVE renal analysis.
Publication TypeJournal Article
Year of Publication2011
AuthorsAthyros, V. G., Hatzitolios A. I., Karagiannis A., Savopoulos C., Katsiki N., Tziomalos K., Papagianni A., Kakafika A., Gossios T. D., & Mikhailidis D. P.
Corporate AuthorsIMPERATIVE Collaborative Group
JournalArch Med Sci
Volume7
Issue6
Pagination984-92
Date Published2011 Dec 31
ISSN1896-9151
Abstract

INTRODUCTION: The short-term effects of multifactorial intervention for cardiovascular disease (CVD) prevention on renal function and serum uric acid (SUA) levels in patients with stage 3 chronic kidney disease (CKD) and multiple CVD risk factors are unclear. The aim of the study was to prospectively assess these effects.MATERIAL AND METHODS: This post hoc analysis of 5 "best practice" studies involved patients with multiple CVD risk factors. Estimated glomerular filtration rate (eGFR) was assessed using the Modification of Diet in Renal Disease (MDRD) formula. Among the 4,153 patients, 1,235 (29.7%) had stage 3 CKD (eGFR between 30 and 59 ml/min/1.73 m(2)). A baseline visit was followed by a concerted effort from previously trained physicians to improve adherence to lifestyle advice and optimize drug treatment, including a statin, for all vascular risk factors. After 6 months eGFR and SUA levels were re-evaluated.RESULTS: The intervention improved compliance to lifestyle measures and increased the use of evidence-based medication, including a statin. There was also a 5.6% increase in eGFR (p < 0.001) in patients with stage 3 CKD and a 6.1% reduction in SUA levels (p < 0.001). Among patients with stage 3 CKD, 127 (10.3%) improved to stage 2 CKD and 9 (0.7%) advanced to stage 4 CKD by the end of the 6-month study period. There were no major side-effects.CONCLUSIONS: Multitargeted intervention, including a statin, may improve renal function and reduce SUA levels within 6 months, thus offsetting 2 potential CVD risk factors in high-risk patients.

DOI10.5114/aoms.2011.26610
Alternate JournalArch Med Sci
PubMed ID22328881
PubMed Central IDPMC3264990

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