Increased targeting of cardiovascular risk factors in patients with chronic kidney disease does not improve atheroma burden or cardiovascular function.
BACKGROUND
Although multiple risk factor intervention (MRFI) is recommended to reduce the increased morbidity and mortality of cardiovascular disease (CVD) in chronic kidney disease (CKD), its efficacy is unknown. We studied the efficacy of a MRFI program in CKD.


METHODS
This randomized controlled study of 200 patients with stage 4 or 5 CKD compared a physician-supervised, nurse-driven MRFI clinic (focused on dyslipidemia, hyperhomocysteinemia, blood pressure [BP], anemia, and hyperphosphatemia) with conventional care in CKD. One hundred eleven subjects completed 2 years of follow-up (median follow-up 674 days [interquartile range {IQR} 348-719 days]). Outcome measures were atheroma burden (carotid intimamedia thickness [IMT]) and endothelial function (brachial artery reactivity [BAR]).


RESULTS
The MRFI group showed significant improvements, compared with usual care, in serum low-density lipoprotein cholesterol (-30.9 mg/dL vs -12.7 mg/dL, P = .001), homocysteine (-6.95 vs -0.67 micromol/L, P < .001), systolic BP (-6.9 vs -0.2 mm Hg, P = .049), and diastolic BP (-4.8 vs -1.0 mm of Hg, P = .043). No significant changes were seen in serum phosphate or hemoglobin level. Despite observed improvements in risk factors, no differences from baseline were demonstrated for IMT (-0.00 vs -0.01 mm, P = .533) or BAR (0.09% vs 0.22%, P = .834). Forty-two patients reached a composite end point of CVD death, acute coronary syndrome, revascularization, nonfatal stroke, and amputation and this was similar between groups (23 vs 19 events, P = .475).


CONCLUSIONS
A MRFI program was not associated with improvement in vascular structure or function in stage 4 or 5 patients with CKD.
Isbel
Nicole M
NM
Department of Renal Medicine, Princess Alexandra Hospital, Brisbane, Australia. nikky_isbel@health.qld.gov.au
Haluska
Brian
B
Johnson
David W
DW
Beller
Elaine
E
Hawley
Carmel
C
Marwick
Thomas H
TH
D000328:Adult; D001794:Blood Pressure; D002097:C-Reactive Protein / Q000032:analysis; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D008078:Cholesterol, LDL / Q000032:analysis; D002908:Chronic Disease; D004730:Endothelium, Vascular / Q000503:physiopathology; D006801:Humans; D020138:Hyperhomocysteinemia / Q000453:epidemiology; D007674:Kidney Diseases / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010346:Patient Care Management; D012307:Risk Factors
D008078:Cholesterol, LDL; D002097:C-Reactive Protein