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Dipyridamole decreases dialysis risk and improves survival in patients with pre-dialysis advanced chronic kidney disease.

ABSTRACT: Dipyridamole decreases proteinuria and improves renal function progression in patients with glomerular disease through its inhibition of platelet activation and enhanced nitric oxide expression. Few studies have evaluated the effects of dipyridamole on renal outcome or survival in CKD stage 5 patients who have not yet received dialysis (CKD 5 ND).A prospective cohort study was conducted based on the Taiwan National Health Insurance Research Database. From January 1, 2000 to June 30, 2009, we enrolled 28,497 patients who had a serum creatinine > 6 mg/dL and a hematocrit < 28% and who were treated with erythropoiesis-stimulating agents (ESAs). All patients were further divided into two groups with or without dipyridamole use within 90 days after starting ESA therapy. Patient followed-up took place until dialysis, death before initiation of dialysis or December 31, 2009. The primary outcomes were long-term dialysis and death before initiating dialysis.The dipyridamole users and nonusers groups included 7,746 and 20,751 patients, respectively. We found that 20,152 patients (70.7%) required long-term dialysis and 5,697 patients (20.0%) died before a progression to end-stage renal disease required dialysis. After propensity score-matching, dipyridamole users were associated with lower risks for long-term dialysis (adjusted HR, 0.96; 95% CI, 0.93-0.99) and death (adjusted HR, 0.91; 95% CI, 0.85-0.97) compared with nonusers.Dipyridamole exhibited a protective effect in reducing the risk for long-term dialysis and death among CKD 5 ND patients. Randomized studies are needed to validate this association.

SUBMITTER: Kuo KL

PROVIDER: S-EPMC5797055 | biostudies-literature | 2018 Jan

REPOSITORIES: biostudies-literature

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Dipyridamole decreases dialysis risk and improves survival in patients with pre-dialysis advanced chronic kidney disease.

Kuo Ko-Lin KL Hung Szu-Chun SC Tseng Wei-Cheng WC Liu Jia-Sin JS Lin Ming-Huang MH Hsu Chih-Cheng CC Tarng Der-Cherng DC

Oncotarget 20170803 4

<h4>Introduction</h4>Dipyridamole decreases proteinuria and improves renal function progression in patients with glomerular disease through its inhibition of platelet activation and enhanced nitric oxide expression. Few studies have evaluated the effects of dipyridamole on renal outcome or survival in CKD stage 5 patients who have not yet received dialysis (CKD 5 ND).<h4>Materials and methods</h4>A prospective cohort study was conducted based on the Taiwan National Health Insurance Research Data ...[more]

PMID: 29435184

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Project description:Background In participants with concomitant chronic coronary disease and advanced chronic kidney disease (CKD), the effect of treatment strategies on the timing of dialysis initiation is not well characterized. Methods and Results In ISCHEMIA-CKD (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches-Chronic Kidney Disease), 777 participants with advanced CKD and moderate or severe ischemia were randomized to either an initial invasive or conservative management strategy. Herein, we compare the proportion of randomized participants with non-dialysis-requiring CKD at baseline (n=362) who initiated dialysis and compare the time to dialysis initiation between invasive versus conservative management arms. Using multivariable Cox regression analysis, we also sought to identify the effect of invasive versus conservative chronic coronary disease management strategies on dialysis initiation. At a median follow-up of 23 months (25th-75th interquartile range, 14-32 months), dialysis was initiated in 18.9% of participants (36/190) in the invasive strategy and 16.9% of participants (29/172) in the conservative strategy (P=0.22). The median time to dialysis initiation was 6.0 months (interquartile range, 3.0-16.0 months) in the invasive group and 18.2 months (interquartile range, 12.2-25.0 months) in the conservative group (P=0.004), with no difference in procedural acute kidney injury rates between the groups (7.8% versus 5.4%; P=0.26). Baseline clinical factors associated with earlier dialysis initiation were lower baseline estimated glomerular filtration rate (hazard ratio [HR] associated with 5-unit decrease, 2.08 [95% CI, 1.72-2.56]; P<0.001), diabetes (HR, 2.30 [95% CI, 1.28-4.13]; P=0.005), hypertension (HR, 7.97 [95% CI, 1.09-58.21]; P=0.041), and Hispanic ethnicity (HR, 2.34 [95% CI, 1.22-4.47]; P=0.010). Conclusions In participants with non-dialysis-requiring CKD in ISCHEMIA-CKD, randomization to an invasive chronic coronary disease management strategy (relative to a conservative chronic coronary disease management strategy) is associated with an accelerated time to initiation of maintenance dialysis for kidney failure. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01985360.

Project description:Background and objectivesOutcomes of older patients with ESRD undergoing RRT or conservative management (CM) are uncertain. Adequate survival data, specifically of older patients, are needed for proper counseling. We compared survival of older renal patients choosing either CM or RRT.Design, setting, participants, & measurementsA retrospective survival analysis was performed of a single-center cohort in a nonacademic teaching hospital in The Netherlands from 2004 to 2014. Patients with ESRD ages ≥70 years old at the time that they opted for CM or RRT were included. Patients with acute on chronic renal failure needing immediate start of dialysis were excluded.ResultsIn total, 107 patients chose CM, and 204 chose RRT. Patients choosing CM were older (mean±SD: 83±4.5 versus 76±4.4 years; P<0.001). The Davies comorbidity scores did not differ significantly between both groups. Median survival of those choosing RRT was higher than those choosing CM from time of modality choice (median; 75th to 25th percentiles: 3.1, 1.5-6.9 versus 1.5, 0.7-3.0 years; log-rank test: P<0.001) and all other starting points (P<0.001 in all patients). However, the survival advantage of patients choosing RRT was no longer observed in patients ages ≥80 years old (median; 75th to 25th percentiles: 2.1, 1.5-3.4 versus 1.4, 0.7-3.0 years; log-rank test: P=0.08). The survival advantage was also substantially reduced in patients ages ≥70 years old with Davies comorbidity scores of ≥3, particularly with cardiovascular comorbidity, although the RRT group maintained its survival advantage at the 5% significance level (median; 75th to 25th percentiles: 1.8, 0.7-4.1 versus 1.0, 0.6-1.4 years; log-rank test: P=0.02).ConclusionsIn this single-center observational study, there was no statistically significant survival advantage among patients ages ≥80 years old choosing RRT over CM. Comorbidity was associated with a lower survival advantage. This provides important information for decision making in older patients with ESRD. CM could be a reasonable alternative to RRT in selected patients.

Project description:BackgroundChronic Kidney Disease (CKD) is common and its prevalence has increased steadily over several decades. Monitoring of rates and severity of CKD across populations is critical for policy development and resource planning. Administrative health data alone has insufficient sensitivity for this purpose, therefore utilizing population level laboratory data and novel methodology is required for population-based surveillance. The aims of this study include a) develop the Manitoba CKD Cohort, b) estimate CKD prevalence, c) identify individuals at high risk of progression to kidney failure and d) determine rates of comorbid health conditions.MethodsAdministrative health and laboratory data from April 1996 to March 2012 were linked from the data repository at the Manitoba Centre for Health Policy. Prevalence was estimated using three methods: a) all CKD cases in administrative and laboratory databases; b) all CKD cases captured only through the laboratory data; c) and the capture-recapture method. Patients were stratified by risk by estimated Glomerular Filtration Rate (eGFR) and albuminuria based on Kidney Disease Improving Global Outcomes (KDIGO) criteria. For comorbid health conditions, the counts were modelled using a Generalized Linear Model (GLM).ResultsThe Manitoba CKD Cohort consisted of 55,876 people with CKD. Of these, 18,342 were identified using administrative health data, 27,393 with laboratory data, and 10,141 people were identified in both databases. The CKD prevalence was 5.6% using the standard definition, 10.6% using only people captured by the laboratory data and 10.6% using the capture-recapture method. Of the identified cases, 46% were at high risk of progression to end-stage kidney disease (ESKD), 41% were at low risk and 13% were not classified, due to unavailable laboratory data. High risk cases had a higher burden of comorbid conditions.ConclusionThis study reports a novel methodology for population based CKD surveillance utilizing a combination of administrative health and laboratory data. High rates of CKD at risk of progression to ESKD have been identified with this approach. Given the high rates of comorbidity and associated healthcare costs, these data can be used to develop a targeted and comprehensive public health surveillance strategy that encompass a range of interrelated chronic diseases.

Dataset Information

Dipyridamole decreases dialysis risk and improves survival in patients with pre-dialysis advanced chronic kidney disease.

Publications

Dipyridamole decreases dialysis risk and improves survival in patients with pre-dialysis advanced chronic kidney disease.

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