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?:abstract
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Background: Chronic Kidney Disease (CKD) is associated with traditional cardiovascular risk factors They are exposed to uraemia related inflammation, oxidative stress and abnormal calcium-phosphorus metabolism Dedicated studies for ACS in severe CKD are limited We analyse patients with severe CKD who present to hospital with ACS in the Auckland region Method: Patients with CKD stage IV-V or end stage kidney disease on dialysis (ESKD) who presented to hospital between 2012-2019 with ACS in the Auckland region were identified from the national ANZACS-QI registry Clinical details and management were obtained from clinical records Results: 229 patients were identified Mean age 65±11y Comprising 80 (34 9%) male, predominantly Pacific Islanders 91 (39 7%), Europeans 51 (22 3%), NZ Māori 35 (15%) 18% presented with STEMI, 82% NSTEACS 130 patients (57%) had stage IV to V CKD and 99 (43%) were dialysis dependent (40% peritoneal dialysis, 60% hemodialysis) Main aetiology of CKD is diabetic nephropathy (60%) followed by hypertensive nephropathy (11%) They have high burden of risk factors including 84% hypertension, 79% diabetes, 48% dyslipidaemia, 53% with prior history of myocardial infarction Over half of the patient presents with congestive heart failure and 3 1% with cardiac arrest One third have left ventricular ejection fraction of <30% during index admission They have a high mean GRACE score 133±32 Mean survival is 3 4±0 2 years after ACS, worse if dialysis dependent at 2 5±0 25 years Conclusion: Patients with severe CKD who present with ACS are comorbid with a high risk of short and long term mortality This is worse in those established on dialysis
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