Coronary revascularisation in patients with chronic kidney disease and end‐stage renal disease: A meta‐analysis

Abstract

Objectives To compare coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for revascularising coronary arteries in patients with chronic kidney disease (CKD) and end‐stage renal disease (ESRD). CKD is described as a continuous decrease in the glomerular filtration rate or abnormalities in kidney structure or function. Methods PubMed, Cochrane Library and Embase databases were searched for studies on the revascularisation of coronary arteries in patients with CKD and ESRD. Results Since no randomised controlled trials (RCTs) have addressed this issue so far, 31 observational studies involving 74 805 patients were included in this meta‐analysis. Compared with PCI, patients undergoing CABG have significantly higher early mortality (CKD: RR = 1.62, 95% CI: 1.17‐2.25, pheterogeneity = 0.476, I2 = 0; ESRD: RR = 1.99, 95% CI: 1.46‐2.71, pheterogeneity = 0.001, I2 = 66.9%). Patients with ESRD undergoing CABG have significantly lower all‐cause mortality (RR = 0.95, 95% CI: 0.93‐0.96, pheterogeneity < 0.001, I2 = 82.9%) and cardiac mortality (RR = 0.73, 95% CI: 0.58‐0.92, pheterogeneity = 0.908, I2 = 0). The long‐term risk of repeat revascularisation (CKD: RR = 0.24, 95% CI: 0.19‐0.30, pheterogeneity = 0.489, I2 = 0; ESRD: RR = 0.23, 95% CI: 0.15‐0.34, pheterogeneity = 0.012, I2 = 54.4%) and myocardial infarction (CKD: RR = .57, 95% CI: 0.38‐0.85, pheterogeneity = 0.025, I2 = 49.9%; ESRD: RR = 0.42, 95% CI: 0.40‐0.44, pheterogeneity = 0.49, I2 = 0) remained significantly higher in the PCI group. Conclusions Patients with ESRD, but not CKD, who underwent CABG had significantly lower all‐cause mortality and cardiac mortality. However, CABG was associated with an increased risk of early mortality in patients with CKD or ESRD. Adequately powered, contemporary, prospective RCTs are needed to define the optimal revascularisation strategy for patients with CKD and ESRD.

Comparison of long-term cardiovascular and renal outcomes between percutaneous coronary intervention and coronary artery bypass grafting in multi-vessel disease with chronic kidney disease

“…Several studies have investigated cardiovascular outcomes after PCI or CABG in patients with CKD. While CABG was reported to be associated with a higher risk of short-term mortality and stroke, MI and repeat revascularization were less frequent than in those who had undergone PCI in the long-term follow-up ( 3 , 4 , 13 , 14 ). The majority of these studies designated MACCE as the primary outcome and concluded CABG is associated with fewer adverse events in patients with CKD than in PCI ( 14 , 15 ).…”

“…mortality and stroke, MI and repeat revascularization were less frequent than in those who had undergone PCI in the long-term follow-up (3,4,13,14). The majority of these studies designated MACCE as the primary outcome and concluded CABG is associated with fewer adverse events in patients with CKD than in PCI (14,15).…”

“…Patients with CKD alone have a higher mortality risk after myocardial infarction (MI) than those with diabetes mellitus or a prior history of MI ( 2 ). Several studies have reported that coronary artery bypass grafting (CABG), compared with percutaneous coronary intervention (PCI), is associated with a higher risk of short-term death and stroke but reduced long-term risk of MI or repeat revascularization in patients with CKD ( 3 , 4 ). Patients with CKD are also at risk for acute kidney injury (AKI), a common complication after CABG or PCI ( 5 ), and for progression to end-stage renal disease ( 6 ).…”

Patient delay in chronic kidney disease: A qualitative study

“…[ 1 ] Some patients with CKD will progress to kidney failure, which is the irreversible decline of kidney function, resulting in the accumulation of water, electrolytes, and metabolic waste in the body. [ 2 ] With CKD developing into kidney failure, there are 2 main treatments to maintain life, kidney transplantation and kidney replacement therapy. However, due to the limited number of transplantable organs, kidney replacement therapy has become the only option for most patients with kidney failure, [ 3 ] which has become a serious public health problem, not only because of the dramatic increase in the therapeutic cost but also because of the substantial economic burden and heavy social pressure on individuals, families, and the country.…”

Surgical versus interventional coronary revascularization in kidney transplant recipients: a systematic review and meta-analysis

“…Revascularization strategies are valuable options for these patients. However, previous studies have focused on CKD and ESRD patients [ 5 , 6 ]. On the other hand, only some studies have been conducted on KTRs, with no cumulative evidence regarding the most effective revascularization strategy [ 7 – 10 ].…”