People with kidney disease who have a heart attack are 40 per cent less likely to receive life saving heart procedures such as angioplasty or bypass surgery because of fears it could worsen their kidney disease. A new research study from the University of Calgary published in July in the British Medical Journal suggests that the benefits of these procedures in patients with kidney disease may outweigh their risks.
Studies in people without kidney disease have demonstrated that heart procedures lead to several health benefits including longer life expectancy, and a reduced chance for a second heart attack. However very little information is available on the risks and benefits of these heart procedures in patients with kidney disease.
“Our study suggests that the benefits of angioplasty and bypass surgery following a heart attack may extend to people with kidney disease, without increasing the risks of progression to kidney failure,” says Dr. Matthew James from the University’s Libin Cardiovascular Institute of Alberta and Institute for Public Health, and the lead author of the study.
“After matching people based on their kidney function and with similar propensity to receive a heart procedure, we found that these procedures were associated with a modest increase in the risk that their kidney function could get worse following the procedure, yet no increase in the risks they would require dialysis or progress to kidney failure later in life. Importantly, the use of these procedures was, however, associated with improved survival”.
A team of researchers including cardiologists and nephrologists who worked on the study were able to use unique data sources, including the APPROACH and AKDN databases, to do a large observational study of more than 10,000 individuals to evaluate the risks and benefits of heart procedures in patients who had measures of kidney function. Researchers identified patients admitted to hospital with a heart attack in Southern Alberta between 2004 and 2009, and then followed them for up to five years after they were discharged to monitor their kidney disease progression and survival.
“A key component of quality care for patients with heart disease is timely access to cardiac procedures when necessary. This knowledge will help patients with kidney disease and their doctors decide on the best treatment options following a heart attack”, says Dr. Merril Knudtson, from the University’s Libin Cardiovascular Institute of Alberta, cardiologist and coauthor of the study.
“We didn’t have this information when I had my heart surgery, but the doctors told me I was high risk. I hope this will help other people who are in the situation that I was”, says William Backs, a patient with kidney disease who had an angioplasty and then bypass surgery after a heart attack over 8 years ago.
Approximately one in 10 Canadians have kidney disease, which is among the strongest risk factors for heart disease. Heart disease remains a number one killer in Canada. It is estimated over 400,000 adults in Alberta have kidney disease, and as many as 28,000 of them will suffer a heart attack over the next 10 years.
The study was published in the July 2013 edition of the British Medical Journal. It was funded by the Kidney Foundation of Canada.
Related Media Coverage
“Research finds heart procedures safe for kidney patients” Global News (with Video)