April 28, 2023

Kidney patients report varying preferences for invasive procedures for heart disease

A recent study of kidney patients shows that the vast majority were willing to undergo invasive heart procedures when these were likely to prolong life and reduce their risk of cardiovascular complications, even though these procedures carried some increased risk of kidney failure or dialysis. However, 17% of patients surveyed placed a greater weight on the risks of kidney failure and stated a preference to avoid invasive procedures in these scenarios.

People with kidney disease are at higher risk of heart disease than the general population. Some invasive and surgical procedures can improve cardiovascular outcomes, but may involve some risk of increased kidney damage. Therefore, patients and their care providers must weigh the benefits and risks of these procedures carefully. To better understand patients’ views of these procedures, Dr. Todd Wilson and colleagues surveyed 140 patients with kidney disease who were not on dialysis, between January 2019 and March 2020.

The results reveal that 83% of patients surveyed placed the greatest value on treatment benefits of heart procedures that have the potential to reduce the risk of death or future heart attacks, despite some increase in risk of kidney failure. Meanwhile, the other 17% of patients were opposed to the prospect of invasive heart procedures and the associated risk of kidney injury that could result in the need of dialysis – instead expressing a preference for treatment with medications. The authors of the study note that this latter group of patients were more likely to have received education on dialysis and have chosen conservative care, suggesting that their preferences may have been influenced by knowledge of the impact of kidney failure on quality of life.

The study highlights how important it is for patients and care providers to discuss patient values and preferences together when making decisions about preference-sensitive treatment decisions such as those for heart disease.  These findings are now being used within decision-making tools to support patients and providers in shared decision-making, as part of the APPROACH research project.