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Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.
SUMMARIES FOR PATIENTS
Trial of a Drug to Decrease the Risk for Heart Disease in Patients with Mild Kidney Failure
17 April 2001 | Volume 134 Issue 8 | Page S96
Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians-American Society of Internal Medicine.
The summary below is from the full report titled "Renal Insufficiency as a Predictor of Cardiovascular Outcomes and the Impact of Ramipril: The HOPE Randomized Trial." It is in the 17 April 2001 issue of Annals of Internal Medicine (volume 134, pages 629-636). The authors are JFE Mann, HC Gerstein, J Pogue, J Bosch, and S Yusuf, for the HOPE Investigators.
What is the problem and what is known about it so far?
Severe kidney disease is known to increase the risk for heart (cardiac) disease, but it is not known whether mildly abnormal kidney function increases heart disease risk. The Heart Outcomes and Prevention Evaluation (HOPE) study evaluated people at high risk for heart disease from many causes and the effects of ramipril (a special class of drug that lowers blood pressure) on that risk. This study included many people with mild kidney disease.
Why did the researchers do this particular study?
The researchers reanalyzed the data from the HOPE study to find out whether mild kidney disease itself increased the risk for cardiac disease and whether ramipril could be protective in this particular group of patients.
Who was studied?
9297 patients in the HOPE study who were at high risk for cardiac disease for a variety of reasons.
How was the study done?
Tests of kidney function were performed at the beginning of the study. The participants were then randomly assigned to treatment with either ramipril or an inactive placebo pill and were followed for 3.5 to 5.5 years. Because high blood pressure and diabetes can cause heart disease by themselves, patients with those disorders were analyzed separately. The primary outcomes studied were cardiac death, heart attack, or stroke. Outcomes of secondary interest were the total number of deaths, hospitalizations for heart failure, and performance of surgical procedures to increase blood flow to the heart.
What did the researchers find?
980 participants fulfilled the criteria for mild kidney disease. These people were older; were more likely to be men; had higher blood pressure, more coronary artery disease, and lower levels of "good cholesterol" (high-density lipoprotein cholesterol); and used more medicines to prevent heart attacks and high blood pressure than those with normal kidney function. Even taking those factors into account, mildly abnormal kidney function itself was an important predictor of heart disease. The more abnormal the kidney function, the higher the risks for heart disease and death from any cause. Ramipril substantially reduced the risk for bad outcomes in the patients with reduced kidney function. Ramipril produced no more adverse side effects than did placebo.
What were the limitations of the study?
Reanalysis of data collected for another purpose is not the best way to answer a particular medical question. Also, the data may not apply to the general population since the people studied had preexisting blood vessel disease or had diabetes with at least one other risk factor for heart disease.
What are the implications of the study?
Mild kidney disease should be considered a risk factor for heart disease; drugs such as ramipril may help reduce this risk.
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M. Ravera, M. Re, L. Deferrari, S. Vettoretti, and G. Deferrari Importance of Blood Pressure Control in Chronic Kidney Disease J. Am. Soc. Nephrol., April 1, 2006; 17(4_suppl_2): S98 - S103. [Abstract] [Full Text] [PDF]
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M.K. Jayapaul, R. Messersmith, D.N. Bennett-Jones, P.A. Mead, and D.M. Large The joint diabetic-renal clinic in clinical practice: 10 years of data from a District General Hospital QJM, March 1, 2006; 99(3): 153 - 160. [Abstract] [Full Text] [PDF]
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A. M. O'Hare, D. Bertenthal, K. E. Covinsky, C. S. Landefeld, S. Sen, K. Mehta, M. A. Steinman, A. Borzecki, and L. C. Walter Mortality Risk Stratification in Chronic Kidney Disease: One Size for All Ages? J. Am. Soc. Nephrol., March 1, 2006; 17(3): 846 - 853. [Abstract] [Full Text] [PDF]
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M. Rahman, S. Pressel, B. R. Davis, C. Nwachuku, J. T. Wright Jr., P. K. Whelton, J. Barzilay, V. Batuman, J. H. Eckfeldt, M. A. Farber, et al. Cardiovascular Outcomes in High-Risk Hypertensive Patients Stratified by Baseline Glomerular Filtration Rate Ann Intern Med, February 7, 2006; 144(3): 172 - 180. [Abstract] [Full Text] [PDF]
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Y. Maaravi, M. Bursztyn, R. Hammerman-Rozenberg, A. Cohen, and J. Stessman Moderate renal insufficiency at 70 years predicts mortality QJM, February 1, 2006; 99(2): 97 - 102. [Abstract] [Full Text] [PDF]
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E. Suganuma, Y. Zuo, N. Ayabe, J. Ma, V. R. Babaev, M. F. Linton, S. Fazio, I. Ichikawa, A. B. Fogo, and V. Kon Antiatherogenic Effects of Angiotensin Receptor Antagonism in Mild Renal Dysfunction J. Am. Soc. Nephrol., February 1, 2006; 17(2): 433 - 441. [Abstract] [Full Text] [PDF]
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C. S. Fox, M. G. Larson, R. S. Vasan, C.-Y. Guo, H. Parise, D. Levy, E. P. Leip, C. J. O'Donnell, R. B. D'Agostino Sr., and E. J. Benjamin Cross-Sectional Association of Kidney Function with Valvular and Annular Calcification: The Framingham Heart Study J. Am. Soc. Nephrol., February 1, 2006; 17(2): 521 - 527. [Abstract] [Full Text] [PDF]
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W. Van Biesen, R. Vanholder, N. Veys, F. Verbeke, J. Delanghe, D. De Bacquer, and N. Lameire The importance of standardization of creatinine in the implementation of guidelines and recommendations for CKD: implications for CKD management programmes Nephrol. Dial. Transplant., January 1, 2006; 21(1): 77 - 83. [Abstract] [Full Text] [PDF]
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N. A. Khan, I. Ma, C. R. Thompson, K. Humphries, D. N. Salem, M. J. Sarnak, and A. Levin Kidney Function and Mortality among Patients with Left Ventricular Systolic Dysfunction J. Am. Soc. Nephrol., January 1, 2006; 17(1): 244 - 253. [Abstract] [Full Text] [PDF]
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J. J. Brugts, A. M. Knetsch, F. U. S. Mattace-Raso, A. Hofman, and J. C. M. Witteman Renal Function and Risk of Myocardial Infarction in an Elderly Population: The Rotterdam Study Arch Intern Med, December 12, 2005; 165(22): 2659 - 2665. [Abstract] [Full Text] [PDF]
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M. Tonelli, A. Keech, J. Shepherd, F. Sacks, A. Tonkin, C. Packard, M. Pfeffer, J. Simes, C. Isles, C. Furberg, et al. Effect of Pravastatin in People with Diabetes and Chronic Kidney Disease J. Am. Soc. Nephrol., December 1, 2005; 16(12): 3748 - 3754. [Abstract] [Full Text] [PDF]
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M. Shlipak and C. Stehman-Breen Observational Research Databases in Renal Disease J. Am. Soc. Nephrol., December 1, 2005; 16(12): 3477 - 3484. [Abstract] [Full Text] [PDF]
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D. N. Reddan, L. Szczech, M. V. Bhapkar, D. J. Moliterno, R. M. Califf, E. M. Ohman, P. B. Berger, J. S. Hochman, F. Van de Werf, R. A. Harrington, et al. Renal function, concomitant medication use and outcomes following acute coronary syndromes Nephrol. Dial. Transplant., October 1, 2005; 20(10): 2105 - 2112. [Abstract] [Full Text] [PDF]
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C. S. Fox, M. G. Larson, E. P. Leip, J. B. Meigs, P. W.F. Wilson, and D. Levy Glycemic Status and Development of Kidney Disease: The Framingham Heart Study Diabetes Care, October 1, 2005; 28(10): 2436 - 2440. [Abstract] [Full Text] [PDF]
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R. N. Foley, C. Wang, and A. J. Collins Cardiovascular Risk Factor Profiles and Kidney Function Stage in the US General Population: The NHANES III Study Mayo Clin. Proc., October 1, 2005; 80(10): 1270 - 1277. [Abstract] [PDF]
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M. J. Holzmann, S. Ahnve, N. Hammar, L. Jorgensen, K. Klerdal, K. Pehrsson, and T. Ivert Creatinine clearance and risk of early mortality in patients undergoing coronary artery bypass grafting J. Thorac. Cardiovasc. Surg., September 1, 2005; 130(3): 746 - 746. [Abstract] [Full Text] [PDF]
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A. M. O'Hare, R. A. Rodriguez, and P. Bacchetti Low Ankle-Brachial Index Associated With Rise in Creatinine Level Over Time: Results From the Atherosclerosis Risk in Communities Study Arch Intern Med, July 11, 2005; 165(13): 1481 - 1485. [Abstract] [Full Text] [PDF]
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R. Vanholder, Z. Massy, A. Argiles, G. Spasovski, F. Verbeke, N. Lameire, and for the European Uremic Toxin Work Group (EUTox) Chronic kidney disease as cause of cardiovascular morbidity and mortality Nephrol. Dial. Transplant., June 1, 2005; 20(6): 1048 - 1056. [Abstract] [Full Text] [PDF]
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Z. T. Bloomgarden The European Association for the Study of Diabetes Diabetes Care, May 1, 2005; 28(5): 1250 - 1257. [Full Text] [PDF]
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M. J. Sarnak, R. Katz, C. O. Stehman-Breen, L. F. Fried, N. S. Jenny, B. M. Psaty, A. B. Newman, D. Siscovick, M. G. Shlipak, and and the Cardiovascular Health Study* Cystatin C Concentration as a Risk Factor for Heart Failure in Older Adults Ann Intern Med, April 5, 2005; 142(7): 497 - 505. [Abstract] [Full Text] [PDF]
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K. Kalantar-Zadeh, K. C Abbott, A. K Salahudeen, R. D Kilpatrick, and T. B Horwich Survival advantages of obesity in dialysis patients Am. J. Clinical Nutrition, March 1, 2005; 81(3): 543 - 554. [Abstract] [Full Text] [PDF]
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