November 6, 2009
Kidney Patients’ Heart Health Getting Better
More awareness of treatment, prevention options helping drive these improvements
People with chronic kidney disease are at much greater risk of developing heart problems than people with healthy kidneys, but new data from the U.S. Renal Data System (USRDS) shows some major improvements in their heart health.Increased awareness among doctors that cardiovascular complications can be treated"”and even prevented"”in kidney patients has helped make this progress possible, says Bryan Becker, MD, National Kidney Foundation President.
"It's a big step forward that death from cardiovascular disease is now recognized not only as a major problem but also that we can do something about it," Dr. Becker says. "And yet more attention is still necessary since the death rate from cardiovascular disease for kidney patients still far exceeds the death rate from cardiovascular disease for people who are the same age in the general population."
The new figures, from the USRDS's 2009 Annual Data Report, cover the decade between 1997 and 2007. Over that decade, the incidence of congestive heart failure, in which the heart loses the ability to pump the blood efficiently, fell by 17 percent in kidney patients. Kidney patients' likelihood of cardiac arrest"”when the heart stops beating"”fell 29 percent, while heart attack risk fell 15 percent.
From 1997 to 2007, the report shows, the likelihood of a kidney patient having certain types of cardiovascular treatment increased. The rate of angioplasty, a procedure to open up narrowed arteries in the heart, rose from 12.1 procedures per 1,000 patient years to 14.5 per 1,000 during that time period. Kidney patients were also increasingly likely to receive pacemakers, which are implanted in the chest to restore normal heart rhythm. But the chances of their having open-heart surgery to restore blood flow to the heart actually dropped.
In 2005, the National Kidney Foundation published comprehensive guidelines on evaluating and treating cardiovascular disease in end-stage renal disease patients treated with dialysis or transplant. These guidelines helped boost awareness of how to prevent and treat heart disease in these patients, according to Dr. Becker. "The guideline also provided a concise body of recommendations that practitioners in any environment, be it a regional rural dialysis facility or a large urban academic health center, could follow," he adds.
But more work needs to be done, especially in tackling heart disease risk factors in the early stages of chronic kidney disease, Dr. Becker says. "We have to be vigilant. It is exciting that we can see a downward trend in the U.S. related to cardiovascular complications and mortality for kidney patients but we have more work to do."
More research is needed, he adds, to understand why certain treatments, such as drugs to lower cholesterol, are less effective on dialysis patients than they are in the general population. It's also important to understand how chronic kidney disease-mineral bone disorder, a condition in which the body loses the ability to form bone and process minerals normally, influences cardiovascular health, he says.
Patients with chronic kidney disease should ask their doctor about how kidney disease and heart disease are interrelated, Dr. Becker advises. They should also keep their blood pressure under good control, and ask their doctor about when and how to lower their cholesterol.
To learn more about chronic kidney disease, risk factors, or treatments, contact the National Kidney Foundation at www.kidney.org or (800) 622-9010.