• About
  • Masthead
  • License Content
  • Advertise
  • Submit Press Release
  • RSS/Email List
  • Write for us
  • Contact us
2 Minute Medicine
No Result
View All Result

No products in the cart.

SUBSCRIBE
  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • AccountLog-in/out
    • Subscribe
    • Sign-in
    • My account
2 Minute Medicine
  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • AccountLog-in/out
    • Subscribe
    • Sign-in
    • My account
SUBSCRIBE
2 Minute Medicine
Subscribe
Home All Specialties Cardiology

Comparisons of invasive versus conservative management in chronic kidney disease in the ISCHEMIA-CKD trials

byMichael WongandAlex Chan
July 7, 2022
in Cardiology, Chronic Disease, Nephrology
Reading Time: 2 mins read
0
Share on FacebookShare on Twitter

1. Following invasive or conservative management of chronic coronary disease, patients with chronic kidney disease (CKD) stage 5 were found to have a significantly higher 3-year cumulative incidence of death and nonfatal myocardial infarction than patients with CKD stage 1.

2. In patients who received either conservative or invasive management of chronic coronary disease, there was no significant difference in 3-year cumulative incidence of death or nonfatal myocardial infarction between the two groups across the different stages of chronic kidney disease.

3. Invasive management versus conservative management of chronic coronary disease was associated with significant improvement of quality-of-life parameters 1 year following randomization, as measured by the Seattle Angina Questionnaire summary score, in patients with CKD stages 1, 2, and 3, but not in CKD stages 4 and 5.

Evidence Rating Level: 2 (Good)

Previous trials comparing invasive versus conservative management of patients with chronic coronary disease (CCD) typically exclude or involve very few patients with severe kidney disease. Thus, current treatment guidelines for CCD are not based on evidence that includes varying levels of kidney function. Prior studies have found that decreased kidney function is associated with higher risks of invasive procedures and increased rates of cardiovascular events. Given this, kidney function often influences treatment decisions, and it is important to investigate for any heterogeneity of treatment benefit based on existing kidney function. The International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial recruited patients with varying levels of kidney function. This study is a post-hoc analysis of the ISCHEMIA and ISCHEMIA-CKD trials. The ISCHEMIA trial recruited participants with CCD and randomized them in a 1:1 ratio to either invasive or conservative management. Invasive management included coronary angiography followed by revascularization with either percutaneous intervention or a coronary artery bypass graft in addition to guideline-directed medical therapy (GDMT), while the conservative management group received GDMT only. 5956 participants were included in this analysis with 1889 (32%), 2551 (43%), 738 (12%), 311 (5%), 467 (8%) patients in CKD stages 1, 2, 3, 4, and 5 respectively. The primary clinical outcome was death or nonfatal myocardial infarction (MI), while the primary quality of life (QoL) outcome was based on the Seattle Angina Questionnaire (SAQ) summary score at 1 year after randomization. Patients with CKD stage 5 were found to have a significantly greater 3-year cumulative incidence of death and MI than patients with CKD stage 1 (p<.001). However, in terms of heterogeneity of treatment benefit, there was no significant difference in death or MI between the invasive and conservative management groups across the spectrum of kidney disease (p=.62). With respect to QoL, invasive management was associated with a significant improvement in QoL parameters in patients with CKD stages 1-3 (p<.001), but this significant improvement was not present in patients with CKD stages 4 and 5. Study findings, as with the ISCHEMIA trial, may be used to further inform practitioners during shared decision making with patients on the relative efficacy of invasive versus conservative management at different stages of disease.

Click here to read the study in JAMA Cardiology

Image: PD

RELATED REPORTS

Removal of asymptomatic kidney stones reduces risk of relapse

Germline mutations in CIDEB confer protection from liver disease

Methamphetamine use associated with cardiovascular disease in hospitalized patients

©2022 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.

Tags: chronic kidney diseaseCKDnephrology
Previous Post

High dose dexamethasone does not improve survival in patients with hypoxemic respiratory failure due to COVID-19

Next Post

Community-based and health-care based smoking cessation intervention models have similar efficacy

RelatedReports

Renal stones in women linked with increased risk of coronary heart disease
Emergency

Removal of asymptomatic kidney stones reduces risk of relapse

August 17, 2022
Maternal cell-free DNA sequencing superior to standard aneuploidy screening [CARE Study]
Chronic Disease

Germline mutations in CIDEB confer protection from liver disease

August 9, 2022
Carbon nanotubes ameliorate methamphetamine addiction in mice [PreClinical]
Cardiology

Methamphetamine use associated with cardiovascular disease in hospitalized patients

August 8, 2022
Primary care physicians play substantial role in pediatric mental health
Weekly Rewinds

2 Minute Medicine Rewind August 8, 2022

August 8, 2022
Next Post
Smoking during pregnancy associated with aerobic fitness of children

Community-based and health-care based smoking cessation intervention models have similar efficacy

COVID-19 epidemiologic characteristics in Wuhan, China [Classics Series]

Meeting families, demographic information affect child abuse work-up

Sleep problems may be associated with adolescents receiving welfare services

License Our Award-Winning Physician-Written Medical News and Visual Abstracts

2 Minute Medicine is the leading authoritative medical news licensing service, and the only with reports written by practicing doctors.

LICENSE CONTENT

2MM+ Premium Access

No ads & unlimited access to all current reports, over 9000 searchable archived reports, visual abstracts, Weekly Rewinds, and the online edition of The Classics Series™ textbook.

Subscription Options
2 Minute Medicine

2 Minute Medicine® is an award winning, physician-run, expert medical media company. Our content is curated, written and edited by practicing health professionals who have clinical and scientific expertise in their field of reporting. Our editorial management team is comprised of highly-trained MD physicians. Join numerous brands, companies, and hospitals who trust our licensed content.

Recent Reports

  • Newborn screening for cystic fibrosis improves nutritional outcomes
  • BNT162b2 vaccine reduces rates of COVID-19 omicron variant infection in children
  • Non-contrast CT sensitive and specific for kidney stones [Classics Series]
License Content
Terms of Use | Disclaimer
Cookie Policy
Privacy Statement (EU)
Disclaimer

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.

  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • Account
    • Subscribe
    • Sign-in
    • My account

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.