Coronary artery disease in patients with chronic kidney disease: A clinical update

Qiangjun Cai, Venkata K. Mukku, Masood Ahmad

Research output: Contribution to journalArticle

66 Citations (Scopus)

Abstract

Chronic kidney disease (CKD) is an independent risk factor for coronary artery disease (CAD). Coronary artery disease is the leading cause of morbidity and mortality in patients with CKD. The outcomes of CAD are poorer in patients with CKD. In addition to traditional risk factors, several uremia-related risk factors such as inflammation, oxidative stress, endothelial dysfunction, coronary artery calcification, hyperhomocysteinemia, and immunosuppressants have been associated with accelerated atherosclerosis. A number of uremia-related biomarkers are identified as predictors of cardiac outcomes in CKD patients. The symptoms of CAD may not be typical in patients with CKD. Both dobutamine stress echocardiography and radionuclide myocardial perfusion imaging have moderate sensitivity and specificity in detecting obstructive CAD in CKD patients. Invasive coronary angiography carries a risk of contrast nephropathy in patients with advanced CKD. It should be reserved for those patients with a high risk for CAD and those who would benefit from revascularization. Guideline-recommended therapies are, in general, underutilized in renal patients. Medical therapy should be considered the initial strategy for clinically stable CAD. The effects of statins in patients with advanced CKD have been neutral despite a lipid-lowering effect. Compared to non-CKD population, percutaneous coronary intervention (PCI) is associated with higher procedure complications, restenosis, and future cardiac events even in the drug-eluting stent era in patients with CKD. Compared with PCI, coronary artery bypass grafting (CABG) reduces repeat revascularizations but is associated with significant perioperative morbidity and mortality. Screening for CAD is an important part of preoperative evaluation for kidney transplant candidates.

Original languageEnglish (US)
Pages (from-to)331-339
Number of pages9
JournalCurrent Cardiology Reviews
Volume9
Issue number4
DOIs
StatePublished - 2013

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Chronic Renal Insufficiency
Coronary Artery Disease
Uremia
Percutaneous Coronary Intervention
Morbidity
Kidney
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Stress Echocardiography
Hyperhomocysteinemia
Myocardial Perfusion Imaging
Drug-Eluting Stents
Mortality
Kidney Diseases
Immunosuppressive Agents
Coronary Angiography
Coronary Artery Bypass
Radioisotopes
Atherosclerosis
Coronary Vessels
Oxidative Stress

Keywords

  • Chronic kidney disease
  • Coronary artery disease
  • End-stage renal disease
  • Percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Coronary artery disease in patients with chronic kidney disease : A clinical update. / Cai, Qiangjun; Mukku, Venkata K.; Ahmad, Masood.

In: Current Cardiology Reviews, Vol. 9, No. 4, 2013, p. 331-339.

Research output: Contribution to journalArticle

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