Physicians should be comfortable referring some patients with chronic kidney disease (CKD) for effective stroke prevention surgery, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN). The findings indicate that CKD patients gain a significant benefit from the procedures without an increased risk of dying from surgical complications.
For people who develop blockages in their arteries, physicians recommend surgery to clear the blood vessels and lower the risk of stroke. However, physicians are often hesitant to refer patients with CKD to undergo this type of surgeryŚcalled carotid endarterectomyŚbecause CKD patients have a high risk of complications and death after undergoing invasive surgeries.
Amit Garg MD, PhD, and Anna Mathew, MD (Lawson Health Research Institute and The University of Western Ontario, Canada), and their colleagues wondered about the role of surgery in preventing strokes in CKD patients. They analyzed data from the North American Symptomatic Carotid Endarterectomy Trial (NASCET), and found that carotid endarterectomy dramatically reduces a CKD patient's risk of future strokes. Dr. Garg, Dr. Mathew, and colleagues examined the benefits and risks of carotid endarterectomy in CKD patients by analyzing the NASCET kidney function data (gathered during the course of the trial but unpublished). They examined information from 524 CKD patients and compared it with information from 966 individuals with normal kidney function.
The analysis revealed that when patients with mild to moderate CKD underwent carotid endarterectomy, their risk of stroke was greatly reduced while their risk of death was not increased. The risk of experiencing a stroke over a two-year period was reduced by 82%.
"We hope the results of our important study inform physicians about the appropriateness of carotid endarterectomy surgery for their patients with kidney disease," said Dr. Garg.
The authors report no financial disclosures. Study co-authors include Henry Barnett, MD (The University of Western Ontario, Canada), Michael Eliasziw, PhD (University of Calgary, Canada), PJ Devereaux MD, PhD (McMaster University, Canada), and Jose Merino, MD (National Institute of Neurological Disorders and Stroke), for the North American Symptomatic Carotid Endarterectomy Trial (NASCET) Collaborators.
The article, entitled "Benefit of Carotid Endarterectomy in Patients with Chronic Kidney Disease," will appear online at http://jasn.asnjournals.org/ on December 10, 2009, doi 10.1681/ASN.2009030287.
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