Supplementary Material for: Detection of Atherosclerotic Cardiovascular Disease in Patients with Advanced Chronic Kidney Disease in the Cardiology and Nephrology Communities

Background: Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of morbidity and mortality among patients with chronic kidney disease (CKD) with a glomerular filtration rate of 2 body surface area. The availability of high-quality randomized controlled trial data to guide management for the population with CKD and ASCVD is limited. Understanding current practice patterns among providers caring for individuals with CKD and CVD is important in guiding future trial questions. Methods: A qualitative survey study was performed. An electronic survey regarding the diagnosis and management of CVD in patients with CKD was conducted using a convenience sample of 450 practicing nephrology and cardiology providers. The survey was administered using Qualtrics® (https://www.qualtrics.com). Results: There were a total of 113 responses, 81 of which were complete responses. More than 90% of the respondents acknowledged the importance of CVD as a cause of morbidity and mortality in patients with CKD. Outside the kidney transplant evaluation setting, 5% of the respondents would screen an asymptomatic patient with advanced CKD for ASCVD. Outside the kidney transplant evaluation scenario, the respondents did not opt for invasive management strategies in advanced CKD. Conclusions: The survey results reveal a lack of consensus among providers caring for patients with advanced CKD about the management of ASCVD in this setting. Future randomized controlled trials will be needed to better inform the clinical management of ASCVD in these patients. The limitations of the study include its small sample size and the relatively low response rate among the respondents.

【背景】动脉粥样硬化性心血管疾病（Atherosclerotic Cardiovascular Disease, ASCVD）是肾小球滤过率符合2体表面积标准的慢性肾脏病（Chronic Kidney Disease, CKD）患者发病与死亡的首要病因。目前可用于指导合并动脉粥样硬化性心血管疾病的慢性肾脏病患者临床管理的高质量随机对照试验数据十分有限。明晰照料慢性肾脏病合并心血管疾病个体的临床从业者的当前实践模式，对规划未来临床试验方向具有重要指导价值。
【方法】本研究为定性调查研究。采用便利抽样法，招募450名在职肾脏病学与心血管病学临床从业者，开展针对慢性肾脏病患者心血管疾病诊断与管理的电子问卷调查。本次问卷通过Qualtrics®平台（https://www.qualtrics.com）发放。
【结果】本次调查共回收问卷113份，其中81份为完整有效问卷。超过90%的受访者认可心血管疾病是慢性肾脏病患者发病与死亡的重要诱因。在肾移植评估场景之外，仅5%的受访者会对晚期慢性肾脏病无症状患者开展动脉粥样硬化性心血管疾病筛查。同样在肾移植评估场景之外，受访从业者未选择针对晚期慢性肾脏病患者采用有创管理策略。
【结论】本次调查结果显示，照料晚期慢性肾脏病患者的临床从业者针对该人群的动脉粥样硬化性心血管疾病管理方案尚未达成共识。未来需开展更多随机对照试验，以更好地指导此类患者的动脉粥样硬化性心血管疾病临床管理。本研究的局限性包括样本量较小以及受访者应答率相对偏低。