Lesion and patient subsets: chronic kidney disease

Summary

Chronic kidney disease (CKD) is among the strongest predictors of adverse outcome in patients with coronary artery disease (CAD) undergoing myocardial revascularisation. Similarly, 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 catheterisation and myocardial revascularisation and they are less likely to receive guidelines-directed medical therapy compared to patients with preserved renal function.

Management of CAD in patients with CKD requires careful evaluation of risks and benefits considering that any revascularisation implies the risk of worsening the renal function.

In patients with multi-vessel CAD and moderate CKD (stage 3 or lesser), surgery is preferred to percutaneous coronary intervention (PCI) when the patient’s risk profile is acceptable and life expectancy is reasonable due to the better survival and lower recurrence of ischaemia, in particular when diabetes is the cause of CKD. In patients with severe CKD (stage 4 to 5) or in haemodialysis, the revascularisation strategy must be set taking into account the general condition of the patient and his or her life expectancy, with the less invasive approach being more appropriate for the most fragile and compromised...