Renalism: Bias in the utilization of inpatient cardiac catheterization (CATH) in patients with chronic renal insufficiency (CRI).
ASN 30th Annual Meeting, San Antonio
J Am Soc Nephrol (Sep) 8:134A 1997
CATH of CRI pts with acute coronary syndromes may be underutilized because of concern regarding radiocontrast induced impairment of glomerular filtration rate.
This study comprised 64,116 Medicare recipients with acute myocardial infarction in 7 states in the U.S.A. Patients with a s-creatinine >5.0 mg/dl and dialysis patients were excluded. 15,540 (25.6 %) of the pts had CRI defined as a baseline s-creatinine between 1.5-5.0 mg/dl. CATH was performed in 22.5 % of the CRI pts compared to 39 % of the pts without CRI. Appropriateness ratings for investigations with CATH were similar in both groups. One year survival was 72 % in CRI pts who underwent CATH and 46 % in CRI pts who did not.
Comment: The study shows that CATH was employed significantly less in CRI pts than in pts without CRI. The fear for renal complications should be balanced against the beneficial effect of a higher utilization of CATH, which is strongly suggested by the markedly higher survival in the CRI patients who underwent CATH. (Peter F. Barany, M.D., Stockholm, Sweden)
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ASN 30th Annual Meeting, San Antonio
CRF by organ system : Cardiovascular/Hypertension