Key result
Concurrent CKD linked to ~160% higher in-hospital CHF risk among ACS patients with DM.
Why the study?
Chronic kidney disease and diabetes mellitus are highly prevalent and morbid, especially among patients presenting with acute coronary syndromes, but outcomes with both conditions needed evaluation.
Does concurrent chronic kidney disease alter the clinical presentation and in-hospital outcomes of acute coronary syndrome patients with diabetes mellitus?
Cohort (n=150)
No
Does concurrent chronic kidney disease alter the clinical presentation and in-hospital outcomes of acute coronary syndrome patients with diabetes mellitus?
Absolute Event Rate: 58.7% vs 22.6%
p-value: p=<0.001
In patients with diabetes presenting with ACS, concurrent CKD is associated with older age, higher rates of hypertension, atypical presentations such as dyspnea, and a higher prevalence of NSTEMI.
Concurrent CKD was associated with higher in-hospital heart failure risk in ACS with diabetes; hypothesis-generating for targeted risk stratification.
Background: Chronic kidney disease (CKD) and Diabetes Mellitus (DM) are highly prevalent, morbid diseases in every population. They are even more common among patients presenting with acute coronary syndromes (ACS). Objective: The present study was, conducted to see the outcome of ACS patients with concurrent DM and CKD. Methods: The cohort study was carried out in the Department of Medicine, Dhaka Medical College & Hospital, Dhaka over a period six months from July 2017 to December 2017. All acute coronary syndrome patients having DM with or without CKD admitted in Medicine and Cardiology (CCU) Departments were the study population. ACS patients with concurrent DM with CKD formed the cohort group (n = 75) and DM without CKD were termed as control group (n = 75). Result: The study was concluded that the ACS patients with concomitant CKD and DM (cohort) are usually older and more often hypertensive than the ACS patients with CKD alone (control) (63.9 vs. 55.9 years, p < 0.001 and 92% vs. 64%, p < 0.001 respectively). The typical chest pain is less commonly observed (68% vs. 86.7%, p = 0.003) and dyspnoea is more often present in this cohort than those in the control (92% vs. 52%, p < 0.001). NSTEMI is significantly present in the cohort compared that in the control group (p < 0.001). Serum Troponin I, CKMB and eGFR were significantly higher in the former group than those in the latter group (p = 0.044, p = 0.050 and p < 0.001 respectively). Almost all the outcome parameters demonstrated their significance. Conclusion: The diabetic with CKD (cohort group) is less likely to have ST elevations but is significantly prevalent having NSTEMI. Typical angina is less and dyspnea is more in cohort group. Bangladesh Medical Res Counc Bull 2022; 48: 133-137
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Adnan et al. (2023) conducted a cohort in Acute Coronary Syndrome with Diabetes Mellitus (n=150). Concurrent Chronic Kidney Disease (CKD) vs. No Chronic Kidney Disease (CKD) was evaluated on Congestive heart failure (p=<0.001). In patients with acute coronary syndrome and diabetes mellitus, the presence of concurrent chronic kidney disease significantly increased the rate of in-hospital congestive heart failure compared to those without chronic kidney disease (58.7% vs 22.6%).
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