Coronary revascularization in patients with chronic kidney disease

Summary

Chronic kidney disease (CKD), as defined as low glomerular filtration rate and/or presence of marker of renal damage, is a widespread disease with a global prevalence of more than 9%. It is among the strongest predictors of adverse outcomes in patients with coronary artery disease (CAD) undergoing myocardial revascularization. In turn, cardiovascular morbidity, and especially CAD, is the main cause of death in patients with CKD. 

Even though CKD patients have an increased cardiovascular risk profile, they have lower rates of cardiac catheterization and myocardial revascularization procedures, and they are less likely to receive optimal guidelines-directed medical therapy compared to patients with preserved renal function. 

Management of CAD in CKD requires careful evaluation of risks and benefits, taking into account the potential threat posed by endovascular or surgical procedures and iodinated contrast medium administration. 

The stage of renal dysfunction, the presence of severe comorbidities, the extension and severity of CAD, and the overall life expectancy of the patient are key factors for individualizing the revascularization strategy. A surgical approach is generally recommended for patients with multi-vessel CAD and moderate CKD (stage 3 or lesser), with an acceptable risk profile and reasonable life expectancy, due to the lower risk of...