{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T08:18:19Z","timestamp":1781079499268,"version":"3.54.1"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Quality and Outcomes"],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>\n              Patients with chronic kidney disease (CKD) on dialysis (CKD G5D) have worse cardiovascular outcomes than patients with advanced nondialysis CKD (CKD G4-5: estimated glomerular filtration rate &lt;30 mL\/[min\u00b71.73m\n              <jats:sup>2<\/jats:sup>\n              ]). Our objective was to evaluate the relationship between achievement of cardiovascular guideline-directed medical therapy (GDMT) goals and clinical outcomes for CKD G5D versus CKD G4-5.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>This was a subgroup analysis of ISCHEMIA-CKD (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches\u2014Chronic Kidney Disease) participants with CKD G4-5 or CKD G5D and moderate-to-severe myocardial ischemia on stress testing. Exposures included dialysis requirement at randomization and GDMT goal achievement during follow-up. The composite outcome was all-cause mortality or nonfatal myocardial infarction. Individual GDMT goal (smoking cessation, systolic blood pressure &lt;140 mm\u2009Hg, low-density lipoprotein cholesterol &lt;70 mg\/dL, statin use, aspirin use) trajectory was modeled. Percentage point difference was estimated for each GDMT goal at 24 months between CKD G5D and CKD G4-5, and for association with key predictors. Probability of survival free from all-cause mortality or nonfatal myocardial infarction by GDMT goal achieved was assessed for CKD G5D versus CKD G4-5.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>A total of 415 CKD G5D and 362 CKD G4-5 participants were randomized. Participants with CKD G5D were less likely to receive statin (\u20136.9% [95% CI, \u201310.3% to \u20133.7%]) and aspirin therapy (\u22123.0% [95% CI, \u22125.6% to \u22120.6%]), with no difference in other GDMT goal attainment. Cumulative exposure to GDMT achieved during follow-up was associated with reduction in all-cause mortality or nonfatal myocardial infarction (hazard ratio, 0.88 [95% CI, 0.87\u20130.90]; per each GDMT goal attained over 60 days), irrespective of dialysis status.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>CKD G5D participants received statin or aspirin therapy less often. Cumulative exposure to GDMT goals achieved was associated with lower incidence of all-cause mortality or nonfatal myocardial infarction in participants with advanced CKD and chronic coronary disease, regardless of dialysis status.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Registration:<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              ; Unique identifier: NCT01985360.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circoutcomes.122.008995","type":"journal-article","created":{"date-parts":[[2022,10,4]],"date-time":"2022-10-04T09:00:21Z","timestamp":1664874021000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Guideline-Directed Medical Therapy Attainment and Outcomes in Dialysis-Requiring Versus Nondialysis Chronic Kidney Disease in the ISCHEMIA-CKD Trial"],"prefix":"10.1161","volume":"15","clinical-trial-number":[{"clinical-trial-number":"nct01985360","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5582-3165","authenticated-orcid":true,"given":"Roy O.","family":"Mathew","sequence":"first","affiliation":[{"name":"Department of Medicine, Loma Linda VA Health Care System, CA (R.O.M.)."},{"name":"Loma Linda University School of Medicine, Loma Linda, CA (R.O.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4867-8588","authenticated-orcid":true,"given":"David J.","family":"Maron","sequence":"additional","affiliation":[{"name":"Department of Medicine, Stanford University School of Medicine, CA (D.J.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Anthopolos","sequence":"additional","affiliation":[{"name":"NYU Grossman School of Medicine, New York, NY (R.A., D.M.C., J.S.H., S.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerome L.","family":"Fleg","sequence":"additional","affiliation":[{"name":"National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean M.","family":"O\u2019Brien","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Duke University School of Medicine, Durham, SC (S.M.O., F.W.R.)."},{"name":"Duke Clinical Research Institute, Department of Biostatistics &amp; Bioinformatics, Duke University School of Medicine, (S.M.O., F.W.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3732-4765","authenticated-orcid":true,"given":"Frank W.","family":"Rockhold","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Duke University School of Medicine, Durham, SC (S.M.O., F.W.R.)."},{"name":"Duke Clinical Research Institute, Department of Biostatistics &amp; Bioinformatics, Duke University School of Medicine, (S.M.O., F.W.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2105-8186","authenticated-orcid":true,"given":"Carlo","family":"Briguori","sequence":"additional","affiliation":[{"name":"Mediterranea Cardiocentro, Naples, Italy (C.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0761-426X","authenticated-orcid":true,"given":"Marek F.","family":"Roik","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Cardiology, Infant Jesus Teaching Hospital, Medical University of Warsaw, Poland (M.F.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3693-8741","authenticated-orcid":true,"given":"Tomasz","family":"Mazurek","sequence":"additional","affiliation":[{"name":"Medical University of Warsaw, Poland (T.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcin","family":"Demkow","sequence":"additional","affiliation":[{"name":"National Institute of Cardiology, Warsaw, Poland (M.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3127-6395","authenticated-orcid":true,"given":"Robert","family":"Malecki","sequence":"additional","affiliation":[{"name":"Nephrology Department of MSS in Warsaw, Poland (R.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiming","family":"Ye","sequence":"additional","affiliation":[{"name":"Guangdong Provincial People\u2019s Hospital, Guangdong, China (Z.Y.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Upendra","family":"Kaul","sequence":"additional","affiliation":[{"name":"Batra Hospital and Medical Research Center, New Delhi, India (U.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0017-468X","authenticated-orcid":true,"given":"Marius","family":"Miglinas","sequence":"additional","affiliation":[{"name":"Vilnius University, Nephrology Center, Santaros Klinikos Hospital, Lithuania (M.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3416-8210","authenticated-orcid":true,"given":"Gregg W.","family":"Stone","sequence":"additional","affiliation":[{"name":"Department of Medicine and Population Health Science and Policy, The Zena and Michael A. 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