The results suggest that patients who follow preventive measures are more likely to stay healthy.

CKD affects more than 1 in 10 adults in the United States and can lead to serious cardiovascular complications and premature death. The National Kidney Foundation has published guidelines on preventive care measures that may help slow disease progression. But how effective are these measures?

Jon Snyder, PhD (United States Renal Data System, Minneapolis), and his colleagues tested their effectiveness by analyzing Medicare data from recent years (approximately 1.2 million patients per year). They classified CKD and diabetes during year one, assessed preventive care during year two, and evaluated heart disease incidence during year three.

The researchers found that increasing preventive measures correlated with lower rates of heart disease. CKD patients who received influenza vaccines and had their lipids, calcium-phosphorus levels, and parathyroid hormone levels (and blood glucose levels if they were diabetic) monitored had lower rates of heart disease and heart-related deaths during the following year.

"Patients using preventive measures had lower cardiovascular disease event rates in the subsequent year, leading us to hypothesize that more diligent care of these patients and evidence-based treatment recommendations are successful at preventing morbid events in the subsequent year," said Dr. Snyder.

Changes in heart disease rates in the following year ranged from 10% lower for those who received influenza vaccinations and two or more blood glucose tests to 43% lower for those who had their calcium-phosphorus levels assessed.

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Analysis included information from 243,222 individuals cared for at the Veterans Health Administration. The incidence of hypoglycemia was higher in patients with CKD versus without, both among patients with diabetes and among those without. The risk of hypoglycemia was highest in individuals with both CKD and diabetes.

Hypoglycemia increased patients' risk of dying in the near term. According to the authors, there was a reduced risk of near term death in individuals with CKD relative to those without and this attenuation in the risk of death might relate to an increased quality of care in these patients with CKD relative to diabetic patients without CKD.

"The association of hypoglycemia with one-day mortality underscores the significance of this metabolic disturbance in patients with diabetes and chronic kidney disease," said Dr. Fink. While details on therapy were not included in this study, the findings are consistent with others that have shown that putting patients on intensive glucose-lowering medications can lead to an increased incidence of hypoglycemia and does not prolong their survival.

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