Medication changes based on echocardiography in dialysis patients

Abstract

Kidney/Disease Outcome Quality Initiative (K/DOQI) guidelines recommend baseline echocardiography at the initiation of dialysis and every 3 years thereafter in patients for early detection of cardiac disease to optimize medical therapy. Because dialysis patients are at increased cardiovascular risk and thus most are already on cardioprotective medications, we hypothesize that serial screening echocardiography will not alter cardioprotective medications in dialysis patients. Retrospective analysis of medication administration of 231 dialysis patients was conducted. Patients were divided into 2 groups, those with and those without echocardiograms. Medication changes post echocardiography were compared with subjects without echocardiograms at comparable time points. The primary end point was the number of medication class changes that occurred in 2 months post echocardiography. Medication classes examined were beta blockers (BB), angiotensin converting enzyme inhibitors or angiotensin receptor blockers (ACEI/ARB), nitrates, calcium channel blockers (CCB), and statins. In the Echo group, there were 29 (19%) subjects with at least 1 medication class change post echocardiography, compared with 121 (81%) subjects without change. The number of patients on specific medication classes before and after echocardiography were BB (90 [60%] vs. 97 [65%], P=0.05), ACEI/ARB (74 [49%] vs. 82 [55%], P=0.01), nitrates (34 [23%] vs. 33 [22%], P=0.56), CCB (77 [51%] vs. 79 [53%], P=0.56), and statins (69 [46%] vs. 70 [47%], P=0.71). When compared with the No Echo group, there was no significant change in number of any medication classes. The occurrence of medication changes post echocardiography in dialysis patients is low and is not different than changes in routine care of dialysis patients without echocardiograms. Thus, serial screening echocardiography may not have added benefit to optimizing medical management of cardiovascular disease in dialysis patients. Further studies are warranted to demonstrate evidence for the use of serial screening echocardiography in this high-risk population.