CKD patients benefit from carotid endarterectomy for stroke prevention

Physicians should be comfortable referring some patients with chronic kidney disease (CKD) for effective stroke prevention surgery, according to a study appearing in a recent issue of the Journal of the American Society Nephrology (JASN) (1).

The findings indicate that CKD patients gain a significant benefit from the procedures without an increased risk of dying from surgical complications.

Physicians are often hesitant to refer patients with CKD to undergo carotid endarterectomy—because these patients have a high risk of complications and death after undergoing invasive surgeries.

Drs Amit Garg 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in CKD patients by analyzing the NASCET kidney function data (gathered during the course of the trial but unpublished).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.

Reference

“Benefit of Carotid Endarterectomy in Patients with Chronic Kidney Disease,” appears online at http://jasn.asnjournals.org/ from December 10, 2009, doi 10.1681/ASN.2009030287.