Coronary Artery Disease in Chronic Kidney Disease: Need for a Heart–Kidney Team-Based Approach

Shroff, Gautam R.; Carlson, Marjorie; Mathew, Roy

doi:10.15420/ecr.2021.30

Cited by 10 publications

(6 citation statements)

References 108 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…CAD significantly negatively impacts the pre-, intra-and post-transplant survival of patients with chronic kidney disease (4). Myocardial revascularization is recommended, as in the general population, in patients with unstable cardiac symptoms or chronic kidney disease for whom coronary intervention provides a long-term survival benefit (5,6). Preventive coronary intervention should not be indicated solely based on the possibility of future transplantation (1).…”

Section: Discussionmentioning

confidence: 99%

Benefits of early transplantation in patients with chronic renal failure undergoing coronary revascularization

Hüseynov¹,

Tekin

Çïçek

et al. 2023

Med Sci Discov

View full text Add to dashboard Cite

Objective: This study aimed to evaluate the effectiveness of post-revascularization surgery in reducing future cardiac events among kidney transplant candidates. Additionally, the role of non-invasive diagnostic techniques and the use of coronary angiography in determining the prognosis of patients scheduled for kidney transplantation were examined. Material and Methods: A retrospective analysis was conducted on 202 renal transplant recipients who underwent their first coronary revascularization procedure after initiating renal replacement therapy between January 2021 and December 2021. Demographic data collected included patient age, sex, race, duration of prior end-stage renal disease, and primary renal diagnosis. Results: The study population consisted of 120 men and 82 women, with a mean age of 56.9 years. Diabetes mellitus (DM) and hypertension (HT) were present in 58.4% and 89.6% of the patients, respectively. Coronary angiography was performed in 30% of patients considered at risk. The median graft rejection time was 145 days according to Kaplan-Meier analysis. Discussion: Coronary artery disease (CAD) has a significant negative impact on the pre-, intra-, and post-transplant survival of patients with chronic kidney disease. Myocardial revascularization is recommended in selected patients with unstable cardiac symptoms or chronic kidney disease, providing long-term survival benefits. Collaborative decision-making between cardiologists and nephrologists is crucial to provide optimal care for this high-risk patient population. Lifestyle modifications, risk factor control, and careful patient selection for myocardial revascularization are key in managing coronary artery disease in chronic kidney disease patients. Conclusion: Managing coronary artery disease in chronic kidney disease patients, especially those who are candidates for kidney transplantation, requires a comprehensive approach. Optimal treatment strategies should consider the intricate relationship between cardiovascular and renal factors. Collaborative care involving cardiologists, nephrologists, and transplant specialists, as well as a focus on both myocardial revascularization and medical therapy, can lead to improved outcomes. Further research is needed to refine treatment guidelines and strategies for this high-risk patient population.

show abstract

Section: Discussionmentioning

confidence: 99%

Benefits of early transplantation in patients with chronic renal failure undergoing coronary revascularization

Hüseynov¹,

Tekin

Çïçek

et al. 2023

Med Sci Discov

View full text Add to dashboard Cite

show abstract

“…The ISCHEMIA-CKD trial, which consisted of 777 CKD subjects, revealed a significantly higher incidence of stroke, death, and initiation of dialysis in subjects who received invasive strategies (coronary angiography and revascularization) [ 19 ]. Both medical and invasive treatment risks and benefits bring a dilemma in daily practices and lead into “therapeutic nihilism” in many CKD subjects [ 19 , 20 ]. The previous study showed CKD patients have more severe CAD than patients with normal kidney function.…”

Section: Discussionmentioning

confidence: 99%

Is It Safe to Do Percutaneous Coronary Intervention in Moderate to Severe Chronic Kidney Disease Patients? A Prospective Cohort Study

Santosa¹,

Harca²,

Yuwono³

et al. 2022

Cureus

View full text Add to dashboard Cite

Introduction: Contrast-induced acute kidney injury (CI-AKI) is a common and potentially serious complication of percutaneous coronary intervention (PCI) procedures, as it induces acute kidney injury (AKI), especially in previously diagnosed chronic kidney disease (CKD) patients, particularly in those who also have diabetes. Adequate hydration and using a minimal volume of contrast media are the recommended measures to decrease CI-AKI in CKD patients. A combination of sodium bicarbonate and N-acetylcysteine (NAC) may be a superior strategy for preventing CI-AKI. This study is aimed to evaluate the safety of PCI in moderate to severe CKD patients.Method: This was a prospective, single-center study, from 2019 to 2021. We included all chronic kidney disease who undergo PCI procedures. The kidney level was measured on admission and 24 hours after the PCI procedure. The patients received 75 meq/500 mL of sodium bicarbonate one to six hours before procedures, oral acetylcysteine 600 mg bid for three days, and rehydration with 1000 ml of normal saline infusion for eight hours in patients without congestive heart failure. SPSS Version 23.0 (IBM SPSS Statistics for Windows, Version 23.0., IBM Corp., Armonk, NY) was used to input and process the data.Results: This study included 118 subjects, with baseline characteristics of age 58.77 ± 9.08 years, 80.5% male, 47.5% diabetic, 50% hypertension, and 59.5% congestive heart failure. From the coronary angiogram, we found most of our subjects (57.6%) had three-vessel disease, 28.8% had two-vessel disease, and 15.6% had one-vessel disease. About 67.8% of subjects used <50 ml of low molecular contrast. The baseline creatinine level was 2.46 ± 1.04 mg/dL and the estimated glomerular filtration rate (eGFR) was 30 ± 12.65 mL/min. There were 19 (16.1%) patients with stage 3A CKD, 45 (38.1%) stage 3B, 41 (34.7%) stage 4, and 41 (34.7%) stage 5. The kidney function test after 24 hours of contrast admission showed a creatinine level of 2.37 ± 1.20 mg/dL (P<0.05) and the eGFR of 34.74 ± 16.10 mL/min. There was no significant difference in creatinine levels between stage 3A and stage 5 CKD. There was a significant reduction in creatinine in stage 3B CKD, from 1.917 ± 0.22 to 1.71 ± 0.37 mg/dL (P = 0.001); and stage 4 CKD, from 2.77 ± 0.55 to 2.72 ± 0.94 mg/dL (P = 0.013).Discussion: CKD is a risk factor for developing CI-AKI after PCI, which is a marker of poor long-term outcomes. The development of CI-AKI is a strong predictor of post-PCI bleeding, which aggravates hemodynamic instability. The combination of NAC and NaHCO 3 exerts a better antioxidative effect, which reduces the harmful short-term and long-term consequences of contrast media. Previous studies revealed the use of low-to-zero contrast media was safer in CKD patients who had undergone PCI. By applying these measures, our study showed a good outcome of PCI with no worsening renal function in CKD patients.Conclusion: With good prophylaxis measures, such as using minimal volume contrast media, adequate rehydration, and the combi...

show abstract

“…Medial calcification is characterized by diffuse calcification of muscular arteries in a circumferential pattern and alteration of their contractile phenotype, while intimal calcification is associated with inflammation and focal occlusion secondary to the formation of atheroma plaque [14]. A meta-analysis of 47 studies, including patients with various stages of CKD and transplanted patients, identified a common prevalence of coronary artery calcifications across CKD stages amounting to ~60%, with an associated nearly two-to fourfold increase in mortality and cardiovascular events [60,61].…”

Section: Atherosclerosis and Vascular Calcificationsmentioning

confidence: 99%

“…The progression of the calcification process in CKD is attributed to increased exposure to calcium and phosphorus due to bone metabolic disorders and the imbalance between factors that promote calcification (receptor activator of nuclear factor-κB and receptor activator of nuclear factor-κB ligand) and factors that inhibit calcification (klotho, osteoprotegerin, and fetuin A) [60,62,63]. Furthermore, CKD disrupts the metabolism of vitamin K, leading to an additional reduction in calcification inhibitors.…”

Section: Atherosclerosis and Vascular Calcificationsmentioning

confidence: 99%

“…Furthermore, CKD disrupts the metabolism of vitamin K, leading to an additional reduction in calcification inhibitors. When vitamin K antagonists (acenocoumarol and warfarin) are utilized to treat CKD patients, they exacerbate the calcification process, contributing to extensive vascular and valvular calcifications in these patients [60,[64][65][66].…”

Section: Atherosclerosis and Vascular Calcificationsmentioning

confidence: 99%

See 1 more Smart Citation

Chronic Kidney Disease Associated with Ischemic Heart Disease: To What Extent Do Biomarkers Help?

Cepoi,

Duca,

Chetran

et al. 2023

Life

View full text Add to dashboard Cite

Chronic kidney disease represents a complex and multifaceted pathology characterized by the presence of structural or functional renal anomalies associated with a persistent reduction in renal function. As the disease progresses, complications arise due to the chronic inflammatory syndrome, hydro-electrolytic disorders, and toxicity secondary to the uremic environment. Cardiovascular complications are the leading cause of death for these patients. Ischemic cardiac pathology can be both a consequence and complication of chronic kidney disease, highlighting the need to identify specific cardiorenal dysfunction biomarkers targeting pathophysiological mechanisms common to both conditions. This identification is crucial for establishing accurate diagnoses, prognoses, and risk stratifications for patients. This work is intended to elucidate the intricate relationship between chronic kidney disease and ischemic heart disease and to investigate the roles of cardiorenal biomarkers, including cardiac troponin, natriuretic peptides, galectin-3, copeptin, fibroblast growth factor 23 and its co-receptor Klotho, soluble suppression of tumorigenicity 2, and plasma growth differentiation factor 15.

show abstract

Coronary Artery Disease in Chronic Kidney Disease: Need for a Heart–Kidney Team-Based Approach

Cited by 10 publications

References 108 publications

Benefits of early transplantation in patients with chronic renal failure undergoing coronary revascularization

Benefits of early transplantation in patients with chronic renal failure undergoing coronary revascularization

Is It Safe to Do Percutaneous Coronary Intervention in Moderate to Severe Chronic Kidney Disease Patients? A Prospective Cohort Study

Chronic Kidney Disease Associated with Ischemic Heart Disease: To What Extent Do Biomarkers Help?

Contact Info

Product

Resources

About