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August 17, 2007Nephrology Dialysis TransplantationOpen Access

Most recent randomized controlled trials of therapeutic interventions (including dialysis dose, statins, and homocysteine lowering) aimed at reducing mortality and cardiovascular events in ESRD have yielded negative results.

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Why the study?

Do therapeutic interventions proven in the general population reduce cardiovascular morbidity and mortality in patients with end-stage renal disease?

Population

Patients with end-stage renal disease (ESRD) on dialysis and pre-dialysis chronic kidney disease (CKD)

Comparison

Various therapeutic interventions including… vs Standard therapy or placebo

Design

Review

Authors

ACAdrian CovicPGPaul Gusbeth–TatomirDGDavid Goldsmith

Discussion

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Overview

General CV interventions lack proven benefit in ESRD; leaves open the need for disease-specific trials.

Structured PICO

Do therapeutic interventions proven in the general population reduce cardiovascular morbidity and mortality in patients with end-stage renal disease?

P
Population
Patients with end-stage renal disease (ESRD) on dialysis and pre-dialysis chronic kidney disease (CKD)
I
Intervention
Various therapeutic interventions including increased dialysis dose, statins, antihypertensives, and homocysteine-lowering therapy
C
Comparator
Standard therapy or placebo
O
Outcome
Cardiovascular morbidity and mortalityhard clinical

This review highlights the consistent failure of traditional cardiovascular risk reduction strategies (like statins and intensive dialysis) to improve survival in ESRD patients, emphasizing the need for disease-specific trials.

Limitations

  • Extrapolating from general population studies is flawed due to unique CV risk profiles in ESRD
  • Many CKD studies are underpowered

Cite This Study

Covic et al. (2007) studied this question.

synapsesocial.com/papers/6a927502de5a63b802a283fehttps://doi.org/10.1093/ndt/gfm706
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