Chapter 12 CVS risk in CKD

12.1 Statins

SHARP (2011): - simvastatin & ezetimibe vs. placebo for primary prevention in CKD. Treatment group had fewer major cardiovascular events.

See also statin therapy in KTRs.

12.2 Coronary intervention

ISCHAEMIA-CKD (2020): - PCI vs medical Rx in CKD IV/V with stable myocardial ischaemia (confirmed on stress testing). Excluded if recent ACS or heart failure. ~60% had T2DM, ~50% were on dialysis. Primary composite outcome of death and non-fatal MI over median follow-up of just over 2 yrs. Invasive strategy had no benefit and caused increase rates of stroke.

12.3 AFib

VALKYRIE (2021): - warfarin vs rivaroxaban 10 mg od vs rivaroxaban plus vit K for AFib on HD. Primary composite endpoint of fatal and non-fatal CVS events. Rivaroxaban was efficacious for the primary endpoint (HR ~0.4) and also caused less major bleeding (HR ~0.4). Reduced rates of limb ischaemia accounted for most of benefit in primary end-point.

RENAL-AF (2022): - open-label trial (PROBE) of apixaban vs warfarin in AF and CHADS-Vasc > 2 on HD (n = 150). Under-powered to evaulate differences in bleeding / thrombotic events. However overall rates of significant bleeding (30% per year) were 10-fold higher than rates of stroke / systemic embolism (3% per year).