{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T14:49:07Z","timestamp":1753886947392,"version":"3.41.2"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2022,3,15]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">In participants with concomitant chronic coronary disease and advanced chronic kidney disease (CKD), the effect of treatment strategies on the timing of dialysis initiation is not well characterized.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              In ISCHEMIA\u2010CKD (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches\u2013Chronic Kidney Disease), 777 participants with advanced CKD and moderate or severe ischemia were randomized to either an initial invasive or conservative management strategy. Herein, we compare the proportion of randomized participants with non\u2013dialysis\u2010requiring CKD at baseline (n=362) who initiated dialysis and compare the time to dialysis initiation between invasive versus conservative management arms. Using multivariable Cox regression analysis, we also sought to identify the effect of invasive versus conservative chronic coronary disease management strategies on dialysis initiation. At a median follow\u2010up of 23\u00a0months (25th\u201375th interquartile range, 14\u201332 months), dialysis was initiated in 18.9% of participants (36\/190) in the invasive strategy and 16.9% of participants (29\/172) in the conservative strategy\n              <jats:italic>(P=<\/jats:italic>\n              0.22). The median time to dialysis initiation was 6.0\u00a0months (interquartile range, 3.0\u201316.0 months) in the invasive group and 18.2\u00a0months (interquartile range, 12.2\u201325.0 months) in the conservative group\n              <jats:italic>(P=<\/jats:italic>\n              0.004), with no difference in procedural acute kidney injury rates between the groups (7.8% versus 5.4%;\n              <jats:italic>P<\/jats:italic>\n              =0.26). Baseline clinical factors associated with earlier dialysis initiation were lower baseline estimated glomerular filtration rate (hazard ratio [HR] associated with 5\u2010unit decrease, 2.08 [95% CI, 1.72\u20132.56];\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001), diabetes (HR, 2.30 [95% CI, 1.28\u20134.13];\n              <jats:italic>P<\/jats:italic>\n              =0.005), hypertension (HR, 7.97 [95% CI, 1.09\u201358.21];\n              <jats:italic>P<\/jats:italic>\n              =0.041), and Hispanic ethnicity (HR, 2.34 [95% CI, 1.22\u20134.47];\n              <jats:italic>P<\/jats:italic>\n              =0.010).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">In participants with non\u2013dialysis\u2010requiring CKD in ISCHEMIA\u2010CKD, randomization to an invasive chronic coronary disease management strategy (relative to a conservative chronic coronary disease management strategy) is associated with an accelerated time to initiation of maintenance dialysis for kidney failure.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Registration<\/jats:title>\n            <jats:p xml:lang=\"en\">\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\/jaha.121.022003","type":"journal-article","created":{"date-parts":[[2022,3,9]],"date-time":"2022-03-09T10:05:12Z","timestamp":1646820312000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Dialysis Initiation in Patients With Chronic Coronary Disease and Advanced Chronic Kidney Disease in ISCHEMIA\u2010CKD"],"prefix":"10.1161","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2105-8186","authenticated-orcid":false,"given":"Carlo","family":"Briguori","sequence":"first","affiliation":[{"name":"Mediterranea Cardiocentro Naples Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5582-3165","authenticated-orcid":false,"given":"Roy O.","family":"Mathew","sequence":"additional","affiliation":[{"name":"Loma Linda VA Health Care System Loma Linda CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhen","family":"Huang","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute Duke University Medical Center Durham NC"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kreton","family":"Mavromatis","sequence":"additional","affiliation":[{"name":"Atlanta VA Healthcare System and Emory University School of Medicine Atlanta GA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7485-336X","authenticated-orcid":false,"given":"LaTonya J.","family":"Hickson","sequence":"additional","affiliation":[{"name":"Mayo Clinic Jacksonville FL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei Ling","family":"Lau","sequence":"additional","affiliation":[{"name":"Division of Nephrology Department of Medicine University of California\u2010Irvine Irvine CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0302-1419","authenticated-orcid":false,"given":"Anoop","family":"Mathew","sequence":"additional","affiliation":[{"name":"University of Alberta Hospital Edmonton Alberta Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandeep","family":"Mahajan","sequence":"additional","affiliation":[{"name":"All India Institute of Medical Sciences Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0745-3478","authenticated-orcid":false,"given":"David C.","family":"Wheeler","sequence":"additional","affiliation":[{"name":"University College London London United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathleen J.","family":"Claes","sequence":"additional","affiliation":[{"name":"Department of Nephrology University Hospitals Leuven Leuven Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gang","family":"Chen","sequence":"additional","affiliation":[{"name":"Peking Union Medical College Hospital Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernando E. B.","family":"Nolasco","sequence":"additional","affiliation":[{"name":"Centro Hospitalar Lisboa Central Lisbon Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3416-8210","authenticated-orcid":false,"given":"Gregg W.","family":"Stone","sequence":"additional","affiliation":[{"name":"Icahn School of Medicine at Mount Sinai New York NY"},{"name":"Cardiovascular Research Foundation New York NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jerome L.","family":"Fleg","sequence":"additional","affiliation":[{"name":"National Heart, Lung, and Blood Institute Bethesda MD"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mandeep S.","family":"Sidhu","sequence":"additional","affiliation":[{"name":"Albany Medical College Albany NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3732-4765","authenticated-orcid":false,"given":"Frank W.","family":"Rockhold","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute Duke University Medical Center Durham NC"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Glenn M.","family":"Chertow","sequence":"additional","affiliation":[{"name":"Stanford University School of Medicine Stanford CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5889-5981","authenticated-orcid":false,"given":"Judith S.","family":"Hochman","sequence":"additional","affiliation":[{"name":"NYU Grossman School of Medicine New York NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David J.","family":"Maron","sequence":"additional","affiliation":[{"name":"Stanford University School of Medicine Stanford CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9485-0652","authenticated-orcid":false,"given":"Sripal","family":"Bangalore","sequence":"additional","affiliation":[{"name":"NYU Grossman School of Medicine New York NY"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1111\/sdi.12155"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2019.01.001"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11255-017-1543-9"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2014.419"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2648.2005.03547.x"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1915925"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2018.07.023"},{"key":"e_1_3_1_9_2","first-page":"S1","article-title":"K\/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification","volume":"39","author":"National Kidney Foundation","year":"2002","unstructured":"National Kidney Foundation . 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