Introduction

The ISCHEMIA-CKD trial showed similar outcomes with an initial conservative vs invasive approach to chronic coronary syndrome in patients with advanced chronic kidney disease. Guideline-directed medical therapy (GDMT) was recommended regardless of the randomized strategy assignment.

Aim

To describe GDMT attainment in ISCHEMIA-CKD participants in Poland compared to other world regions.

Material and methods

Among 777 trial participants, 105 were randomized in Poland. Patients were followed for a median of 2.2 years with the following GDMT recommendations: not smoking, systolic blood pressure (SBP) < 140/ diastolic blood pressure (DBP) < 90 mm Hg, high/moderate-intensity statin, antiplatelet/anticoagulant, angiotensin-converting-enzyme inhibitors (ACE-I)/angiotensin receptor blockers (ARB) and b-blocker therapy, glycated hemoglobin (HbA1c) < 8% when indicated.

Results

Participants in Poland vs other regions of the world (age 67 [60, 76] vs. 63 [55, 70] years, p < 0.001, 32% vs. 31% females, p = 0.86) had higher incidence of prior myocardial infarction (25% vs. 16%, p = 0.04), peripheral vascular disease (12% vs. 5%, p = 0.009), atrial fibrillation (23% vs. 7%, p < 0.001), and less frequently diabetes (44% vs. 59%, p = 0.004). At baseline, Polish participants were more often on antiplatelets/anticoagulants (91% vs. 83%, p = 0.04), b-blockers (95% vs. 72%, p < 0.001), and ACE-I/ARBs (62% vs. 45%, p = 0.002), with better attainment of SBP < 140 (73% vs. 53%, p < 0.001), and HbA1c < 8% (86% vs. 56%, p = 0.003) and similar smoking and high-/moderate-intensity statin treatment frequencies. This degree of GDMT goal attainment was maintained at the last follow-up visit.

Conclusions

In Polish patients with advanced kidney disease, high GDMT goal attainment was observed and maintained until the last follow-up visit under trial-specific, strict medical surveillance. The impact of GDMT on long-term outcomes remains to be studied in this patient population.