Chronic Kidney Disease and Coronary Artery Disease

Sarnak, Mark J.; Amann, Kerstin; Bangalore, Sripal; Cavalcante, João L.; Charytan, David M.; Craig, Jonathan C.; Gill, John S.; Mark, Daniel B.; Jardine, Alan G.; Landmesser, Ulf; Newby, L. Kristin; Herzog, Charles A.; Cheung, Michael; Wheeler, David C.; Winkelmayer, Wolfgang C.; Marwick, Thomas H.

doi:10.1016/j.jacc.2019.08.1017

Cited by 492 publications

(380 citation statements)

References 68 publications

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“…Atypical angina on the other hand is the presentation of clinically relevant ischemia as seen by ECG and non-specific symptoms such as dyspnea or fatigue. This is a common presentation amongst patients with CKD (Sarnak et al, 2019). Microvascular angina, otherwise known as syndrome X, has been a commonly held hypothesis explaining the phenomenon of typical or atypical angina and presence of ST-segment changes in the absence of obstructive coronary disease or wall motion abnormalities.…”

Section: Coronary Microcirculatory Dysfunctionmentioning

confidence: 99%

“…For patients living with chronic kidney disease (CKD), the number one leading cause of morbidity and mortality remains cardiovascular disease (CVD), with some studies showing that greater than 50% of patients with end stage renal disease (ESRD) experience death secondary to cardiovascular disease (Go et al, 2004;Sarnak et al, 2019). Even when taking into account the traditional risk factors such as hypertension, diabetes, and hyperlipidemia, the mere presence of CKD worsens the prognosis of those with coronary artery disease (CAD) (Matsushita et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

“…Beyond the increase in risk for vascular disease, patients with CKD and CAD present differently from CAD-only patients in terms of their clinical presentation and comorbidities. Typical presenting symptoms of CAD are less often seen in CKD patients, and CKD patients more often present with acute coronary syndromes (ACS) as their index of heart disease versus the more common stable ischemic heart disease presentations seen in non-CKD subjects (Sarnak et al, 2019). These peculiarities of CAD in patients with CKD suggest the presence of potentially unique specific pathophysiologic characteristics.…”

Section: Introductionmentioning

confidence: 99%

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Accelerated and intensified calcific atherosclerosis and microvascular dysfunction in patients with chronic kidney disease

Fakhry

Sidhu

Bangalore

et al. 2020

Rev. Cardiovasc. Med.

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Cardiovascular disease, and in particular coronary artery disease (CAD), remains an important contributor of morbidity and mortality among patients with chronic kidney disease (CKD). Classic symptomatology of CAD and effectiveness of established therapeutic measures is less frequent in patients with CKD. This suggests unique characteristics of CAD among patients with CKD. Two important features of CAD in CKD include increased calcific density of atherosclerotic plaques and of the vessels themselves (coronary artery calcification-CAC), as well as a decrease in microcirculatory function-or coronary microcirculatory dysfunction. A multitude of pathophysiologic pathways have been identified that contribute to CAC in CKD; less is known about the pathophysiology of microcirculatory dysfunction. It is not well established if these two processes are directly related to each other, but the combination results in a greater severity of effect on overall myocardial function and may in part explain the greater preponderance of silent myocardial infarction. Further investigation is needed to better understand these unique aspects of CAD in CKD as well as the role they play in overall CVD in this group, and ultimately therapeutics that may lessen the burden of disease.

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Section: Coronary Microcirculatory Dysfunctionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Accelerated and intensified calcific atherosclerosis and microvascular dysfunction in patients with chronic kidney disease

Fakhry

Sidhu

Bangalore

et al. 2020

Rev. Cardiovasc. Med.

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“…One important pathophysiological process that links virtually all forms of kidney disease and their cardiovascular and other complications is inflammation (Swaminathan and Shah, 2011;Kurts et al, 2013;Rabb et al, 2016;Sarnak et al, 2019). It is now well recognized that production of inflammatory mediators is directly triggered by programmed cell death pathways, metabolic dysfunction and endoplasmic reticulum stress within renal parenchymal cells and results in exacerbation of tissue injury during AKI and CKD (Mulay et al, 2016;Sarnak et al, 2019). Furthermore, dysregulated immune cells contribute to progressive fibrosis of the kidney as well as to acceleration of vascular injury in CKD/ESRD (Kurts et al, 2013;Mulay et al, 2016;Rabb et al, 2016;Sarnak et al, 2019).…”

Section: Editorial On the Research Topic Innovative Biologics And Drumentioning

confidence: 99%

“…It is now well recognized that production of inflammatory mediators is directly triggered by programmed cell death pathways, metabolic dysfunction and endoplasmic reticulum stress within renal parenchymal cells and results in exacerbation of tissue injury during AKI and CKD (Mulay et al, 2016;Sarnak et al, 2019). Furthermore, dysregulated immune cells contribute to progressive fibrosis of the kidney as well as to acceleration of vascular injury in CKD/ESRD (Kurts et al, 2013;Mulay et al, 2016;Rabb et al, 2016;Sarnak et al, 2019). Over the past two decades, advancing knowledge of intra-renal inflammatory pathways and of resident and recruited immune cell populations within the kidneys has unearthed new opportunities for the development of mechanistically informed, anti-inflammatory therapies for kidney disease (Kurts et al, 2013).…”

Section: Editorial On the Research Topic Innovative Biologics And Drumentioning

confidence: 99%

Editorial: Innovative Biologics and Drugs to Target Renal Inflammation

Griffin

Swaminathan

2020

Front. Pharmacol.

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Coronary Heart Disease Testing Before Kidney Transplant—A Call for Revised Guidance

2023

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End-stage kidney disease (ESKD) is a debilitating chronic illness for which kidney transplant is the treatment of choice, as it reduces mortality, improves quality of life, and lowers costs compared with dialysis. Professional societies recommend cardiac evaluation for transplant candidacy because patients with ESKD are at increased risk of cardiovascular disease. 1 There has been substantial debate regarding the risks and benefits of such pretransplant evaluation, but to our knowledge few clinical data. To fill this evidence gap, the study in a recent issue of JAMA Internal Medicine by Cheng and colleagues 2 examined the association between pretransplant coronary heart disease (CHD) testing in asymptomatic patients and early postoperative adverse events. Using Medicare data on all 79 334 patients undergoing first-time kidney transplant from 2000 to 2014, they found that pretransplant CHD testing was performed in 56% of patients at the most test-intensive transplant programs compared with 24% at the least testintensive programs. Routine pretransplant CHD testing was not associated with significant reduction in death or acute myocardial infarction within 30 days of transplant. In fact, they found a nonsignificant increase in adverse events at centers with higher rates of CHD testing. Cheng et al 2 were not able to include outcomes of CHD testing in patients who did not proceed to undergo transplant. While the consequences of such testing in patients who are not ultimately listed for transplant is unknown, to our knowledge there is no study in any population that shows a benefit to CHD testing in asymptomatic persons, with or without ESKD.This study should inform professional society guidelines surrounding pretransplant CHD testing. New guidelines from the American Heart Association and American College of Cardiology 3 (and endorsed by the American Society of Transplantation) recommend screening electrocardiogram and echocardiogram for asymptomatic patients with unknown CHD status before transplant listing, updating previous guidelines that recommended noninvasive stress testing regardless of functional status in patients with 3 or more risk factors (diabetes, greater than 1 year receiving dialysis, prior cardiovascular disease, left ventricular hypertrophy, older than 60 years, smoking history, hypertension, or dyslipidemia). 4 The nonprofit

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Chronic Kidney Disease and Coronary Artery Disease

Cited by 492 publications

References 68 publications

Accelerated and intensified calcific atherosclerosis and microvascular dysfunction in patients with chronic kidney disease

Accelerated and intensified calcific atherosclerosis and microvascular dysfunction in patients with chronic kidney disease

Editorial: Innovative Biologics and Drugs to Target Renal Inflammation

Coronary Heart Disease Testing Before Kidney Transplant—A Call for Revised Guidance

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