Coronary revascularization in patients with advanced chronic kidney disease

Publication date: Available online 19 April 2019Source: Canadian Journal of CardiologyAuthor(s): Pierluigi Costanzo, Vladimír DžavíkAbstractPatients with chronic kidney disease (CKD) have an increased risk of obstructive coronary artery disease (CAD), while patients with end stage renal disease (ESRD) on hemodialysis represent a population at particularly high risk of developing cardiac ischemic events. Patients with CKD and acute coronary syndromes (ACS) should be treated the same way as ACS patients without kidney dysfunction. The benefit of revascularization in patients with advanced kidney failure and CAD is unknown. Observational studies suggest that revascularization might confer a survival benefit when compared with medical therapy alone. Little evidence from randomized trials exists regarding the effectiveness of revascularization of patients with CAD with either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) vs medical therapy alone in patients with CKD. The risk of contrast-induced nephropathy is a major concern when performing PCI in patients with CKD. Strict rehydration protocols and techniques to minimize contrast use are paramount to reduce this risk. Finally, in CKD patients awaiting kidney transplantation, a non-invasive or invasive CAD screening approach according to the cardiovascular risk profile should be used. Revascularization should be performed in candidates with critical lesions.
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research