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Journal of Nephrology
Published in: Journal of Nephrology 4/2015

01-08-2015 | Review

How to balance risks and benefits in the management of CKD patients with coronary artery disease

Authors: Giancarlo Marenzi, Nicola Cosentino, Carlo Guastoni

Published in: Journal of Nephrology | Issue 4/2015

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Abstract

Chronic kidney disease (CKD) is associated with a high burden of coronary artery disease (CAD), which remains the most common cause of morbidity and mortality in CKD patients. Although the management of CAD is more challenging in patients with CKD than in the general population, and coupled with concerns about further deterioration of renal function and therapy-related toxic effects, CKD patients and those receiving dialysis have not traditionally been included in randomized trials evaluating either medical or revascularization therapies. Thus, only scant data from small prospective studies or retrospective analyses of controlled trials and registries are available, and to date no optimal treatment approach has been defined for this subgroup of patients. However, they potentially have much to gain from the pharmacological, interventional, and surgical strategies used in the general population. Thus, the objective of this review is to summarize the current evidence regarding the management of CAD in CKD patients, in particular with respect to uncertainties regarding coronary revascularization options, and their risk–benefit relationship in such a high-risk population.
Literature
1.
Collins AJ, Foley R, Herzog C et al (2008) Excerpts from the United States Renal Data System 2007 annual data report. Am J Kidney Dis 51(1 Suppl 1):S1–S320
2.
Herzog CA (2003) How to manage the renal patient with coronary heart disease: the agony and the ecstasy of opinion-based medicine. J Am Soc Nephrol 14:2556–2572PubMedCrossRef
3.
Jungers P, Massey ZA, Khoa TN et al (1997) Incidence and risk factors of atherosclerotic cardiovascular accidents in predialysis chronic renal failure patients: a prospective study. Nephrol Dial Transplant 12:2597–2602PubMedCrossRef
4.
Levin A (2003) Clinical epidemiology of cardiovascular disease in chronic kidney disease prior to dialysis. Semin Dial 16:101–105PubMedCrossRef
5.
Joki N, Hase H, Nakamura R, Yamaguchi T (1997) Onset of coronary artery disease prior to initiation of haemodialysis in patients with end-stage renal disease. Nephrol Dial Transplant 12:718–723PubMedCrossRef
6.
Zebrack JS, Anderson JL, Beddhu S et al (2003) Intermountain Heart Collaborative Study Group. Do associations with C-reactive protein and extent of coronary artery disease account for the increased cardiovascular risk of renal insufficiency? J Am Coll Cardiol 42:57–63PubMedCrossRef
7.
Go AS, Bansal N, Chandra M et al (2011) Chronic kidney disease and risk for presenting with acute myocardial infarction versus stable exertional angina in adults with coronary heart disease. J Am Coll Cardiol 58:1600–1607PubMedCentralPubMedCrossRef
8.
Fox CS, Muntner P, Chen AY et al (2010) Use of evidence-based therapies in short-term outcomes of ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction in patients with chronic kidney disease: a report from the National Cardiovascular Data Acute Coronary Treatment and Intervention Outcomes Network registry. Circulation 121:357–365PubMedCentralPubMedCrossRef
9.
Keeley EC, Kadakia R, Soman S, Borzak S, McCullough PA (2003) Analysis of long-term survival after revascularization in patients with chronic kidney disease presenting with acute coronary syndromes. Am J Cardiol 92:509–514PubMedCrossRef
10.
Shlipak MG, Heidenreich PA, Noguchi H, Chertow GM, Browner WS, McClellan MB (2002) Association of renal insufficiency with treatment and outcomes after myocardial infarction in elderly patients. Ann Intern Med 137:555–562PubMedCrossRef
11.
Santopinto JJ, Fox KA, Goldberg RJ et al (2003) Creatinine clearance and adverse hospital outcomes in patients with acute coronary syndromes: findings from the global registry of acute coronary events (GRACE). Heart 89:1003–1008PubMedCentralPubMedCrossRef
12.
Weber CI, Duchateau-Nguyen G, Solier C et al (2014) Cardiovascular risk markers associated with arterial calcification in patients with chronic kidney disease Stages 3 and 4. Clin Kidney J. 7:167–173CrossRef
13.
Chertow GM, Normand SL, McNeil BJ (2004) “Renalism”: inappropriately low rates of coronary angiography in elderly individuals with renal insufficiency. J Am Soc Nephrol 15:2462–2468PubMedCrossRef
14.
Gruppo Italiano per lo Studio della Streptochinasi nell’Infarto (1986) Miocardico (GISSI). Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Lancet 1:397–402
15.
ISIS-2 (Second International Study of Infarct Survival) Collaborative Group (1988) Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. Lancet 2:349–360
16.
The GUSTO investigators (1993) An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. N Engl J Med 329:673–682CrossRef
17.
Herzog CA, Ma JZ, Collins AJ (1999) Long-term survival dialysis patients receiving thrombolytic therapy for acute myocardial infarction in the United States. J Am Soc Nephrol 10:166A
18.
Gibson CM, Pinto DS, Murphy SA et al (2003) Association of creatinine and creatinine clearance on presentation in acute myocardial infarction with subsequent mortality. J Am Coll Cardiol 42:1535–1543PubMedCrossRef
19.
Hobbach HP, Gibson CM, Giugliano RP et al (2003) The prognostic value of serum creatinine on admission in fibrinolytic-eligible patients with acute myocardial infarction. J Thrombosis Thrombolysis 16:167–174CrossRef
20.
Dragu R, Behar S, Sandach A et al (2006) Should primary percutaneous coronary intervention be the preferred method of reperfusion therapy for patients with renal failure and ST-elevation acute myocardial infarction? Am J Cardiol 97:1142–1155PubMedCrossRef
21.
Medi C, Montalescot G, Budaj A et al (2009) Reperfusion in patients with renal dysfunction after presentation with ST-segment elevation or left bundle branch block: GRACE (Global Registry of Acute Coronary Events). JACC Cardiovasc Interv 2:26–33PubMedCrossRef
22.
Chan MY, Becker RC, Sim LL et al (2010) Reperfusion strategy and mortality in ST-elevation myocardial infarction among patients with and without impaired renal function. Ann Acad Med Singapore 39:179–184PubMed
23.
Bavry AA, Kumbhani DJ, Rassi AN, Bhatt DL, Askari AT (2006) Benefit of early invasive therapy in acute coronary syndromes: a meta-analysis of contemporary randomized clinical trials. J Am Coll Cardiol 48:1319–1325PubMedCrossRef
24.
Januzzi JL, Cannon CP, DiBattiste PM, Murphy S, Weintraub W, Braunwald E (2002) Effects of renal insufficiency on early invasive management in patients with acute coronary syndromes (the TACTICS-TIMI 18 Trial). Am J Cardiol 90:1246–1249PubMedCrossRef
25.
Fragmin and Fast Revascularisation during InStability in Coronary artery disease Investigators (1999) Invasive compared with non-invasive treatment in unstable coronary-artery disease: FRISC II prospective randomised multicentre study. Lancet 354:708–715CrossRef
26.
Charytan DM, Wallentin L, Lagerqvist B et al (2009) Early angiography in patients with chronic kidney disease: a collaborative systematic review. Clin J Am Soc Nephrol 4:1032–1043PubMedCentralPubMedCrossRef
27.
Szummer K, Lundman P, Jacobson SH et al (2009) Influence of renal function on the effects of early revascularization in non-ST-elevation myocardial infarction: data from the Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART). Circulation 120:851–858PubMedCrossRef
28.
Hachinohe D, Jeong MH, Saito S et al (2011) Management of non-ST-segment elevation acute myocardial infarction in patients with chronic kidney disease (from the Korea Acute Myocardial Infarction Registry). Am J Cardiol 108:206–213PubMedCrossRef
29.
Windecker S, Kolh P, Alfonso F (2014) ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 35:2541–2619PubMedCrossRef
30.
Sedlis SP, Jurkovitz CT, Hartigan PM et al (2009) Optimal medical therapy with or without percutaneous coronary intervention for patients with stable coronary artery disease and chronic kidney disease. Am J Cardiol 104:1647–1653PubMedCrossRef
31.
Herzog CA, Ma JZ, Collins AJ (1999) Long-term outcome of dialysis patients in the United States with coronary revascularization procedures. Kidney Int 56:324–332PubMedCrossRef
32.
Szczech LA, Reddan DN, Owen WF et al (2001) Differential survival after coronary revascularization procedures among patients with renal insufficiency. Kidney Int 60:292–299PubMedCrossRef
33.
Herzog CA, Ma JZ, Collins AJ (2002) Comparative survival of dialysis patients in the United States after coronary angioplasty, coronary artery stenting, and coronary artery bypass surgery and impact of diabetes. Circulation 106:2207–2211PubMedCrossRef
34.
Nevis IF, Mathew A, Novick RJ et al (2009) Optimal method of coronary revascularization in patients receiving dialysis: systematic review. Clin J Am Soc Nephrol 4:369–378PubMedCentralPubMed
35.
Hemmelgarn BR, Southern D, Culleton BF et al (2004) Survival after coronary revascularization among patients with kidney disease. Circulation 110:1890–1895PubMedCrossRef
36.
Reddan DN, Szczech LA, Tuttle RH et al (2003) Chronic kidney disease, mortality, and treatment strategies among patients with clinically significant coronary artery disease. J Am Soc Nephrol 14:2373–2380PubMedCrossRef
37.
Le Feuvre C, Dambrin G, Helft G et al (2001) Clinical outcome following coronary angioplasty in dialysis patients: a case-control study in the era of coronary stenting. Heart 85:556–560PubMedCentralPubMedCrossRef
38.
Best PJ, Berger PB, Davis BR et al (2004) Impact of mild or moderate chronic kidney disease on the frequency of restenosis: results from the PRESTO trial. J Am Coll Cardiol 44:1786–1791PubMed
39.
Mauri L, Silbaugh TS, Wolf RE (2008) Long-term clinical outcomes after drug-eluting and bare-metal stenting in Massachusetts. Circulation 118:1817–1827PubMedCentralPubMedCrossRef
40.
Ishio N, Kobayashi T, Takebayashi H et al (2007) Impact of drug-eluting stents on clinical and outcomes in dialysis patients. Circ J 71:1525–1529PubMedCrossRef
41.
Aoyama T, Ishii H, Toriyama T et al (2008) Sirolimus-eluting stents vs bare metal stents for coronary intervention in Japanese patients with renal failure on hemodialysis. Circ J 72:56–60PubMedCrossRef
42.
Das P, Moliterno DJ, Charnigo R et al (2006) Impact of drug-eluting stents on outcomes of patients with end-stage renal disease undergoing percutaneous coronary revascularization. J Invasive Cardiol 18:405–408PubMed
43.
Halkin A, Selzer F, Marroquin O, Laskey W, Detre K, Cohen H (2006) Clinical outcomes following percutaneous coronary intervention with drug-eluting vs. bare-metal stents in dialysis patients. J Invasive Cardiol. 18:577–583PubMed
44.
Ribichini F, Vassanelli C (2014) Drug-eluting stent or coronary artery bypass graft surgery in hemodialysis patients? J Nephrol 27:7–9PubMedCrossRef
45.
Abdel-Latif A, Mukherjee D, Mesgarzadeh P, Ziada KM (2010) Drug-eluting stents in patients with end-stage renal disease: meta-analysis and systematic review of the literature. Catheter Cardiovasc Interv 76:942–948PubMedCrossRef
46.
Charytan DM, Li S, Liu J, Herzog CA (2012) Risks of death and end-stage renal disease after surgical compared with percutaneous coronary revascularization in elderly patients with chronic kidney disease. Circulation 126(11 Suppl 1):S164–S169PubMedCentralPubMedCrossRef
47.
Zheng H, Xue S, Lian F, Huang RT, Hu ZL, Wang YY (2013) Meta-analysis of clinical studies comparing coronary artery bypass grafting with percutaneous coronary intervention in patients with end-stage renal disease. Eur J Cardiothorac Surg 43:459–467PubMedCrossRef
48.
Serruys PW, Onuma Y, Garg S et al (2010) 5-year clinical outcomes of the ARTS II (Arterial Revascularization Therapies Study II) of the sirolimus-eluting stent in the treatment of patients with multivessel de novo coronary artery lesions. J Am Coll Cardiol 55:1093–1101PubMedCrossRef
49.
Berger AK, Herzog CA (2010) CABG in CKD: untangling the letters of risk. Nephrol Dial Transplant 25:3477–3479PubMedCrossRef
50.
Chan W, Ivanov J, Ko D et al (2015) Clinical outcomes of treatment by percutaneous coronary intervention versus coronary artery bypass graft surgery in patients with chronic kidney disease undergoing index revascularization in Ontario. Circ Cardiovasc Interv 8(1)
51.
McCollough PA, Adam A, Becker CR et al (2006) Epidemilogy and prognostic implications of contrast-induced nephropathy. Am J Cardiol 98:5K–13KCrossRef
52.
Weisbord SD, Chen H, Stone RA et al (2006) Associations of increases in serum creatinine with mortality and length of hospital stay after coronary angiography. J Am Soc Nephrol 17:2871–2877PubMedCrossRef
53.
54.
Maioli M, Toso A, Leoncini M et al (2012) Persistent renal damage after contrast-induced acute kidney injury: incidence, evolution, risk factors, and prognosis. Circulation 125:3099–3107PubMedCrossRef
55.
Goldberg A, Hammerman H, Petchreski S et al (2005) In-hospital and 1-year mortality of patients who develop worsening renal function following acute ST-elevation myocardial infarction. Am Heart J 150:330–337PubMedCrossRef
56.
Cruz DN (2013) Cardiorenal syndrome in critical care: the acute cardiorenal and renocardiac syndromes. Adv Chron Kidney Dis 20:56–66CrossRef
57.
Marenzi G, Cabiati A, Bertoli SV et al (2013) Incidence and relevance of acute kidney injury in patients hospitalized with acute coronary syndromes. Am J Cardiol 111:816–822PubMedCrossRef
58.
James MT, Ghali WA, Knudtson ML et al (2011) Associations between acute kidney injury and cardiovascular and renal outcomes after coronary angiography. Circulation 123:409–416PubMedCrossRef
59.
Mariscalco G, Lorusso R, Dominici C, Renzulli A, Sala A (2011) Acute kidney injury: a relevant complication after cardiac surgery. Ann Thorac Surg 92:1539–1547PubMedCrossRef
60.
Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW (2005) Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol 16:3365–3370PubMedCrossRef
61.
Hobson CE, Yavas S, Segal MS et al (2009) Acute kidney injury is associated with increased long-term mortality after cardiothoracic surgery. Circulation 119:2444–2453PubMedCrossRef
62.
Rosner MH, Okusa MD (2006) Acute kidney injury associated with cardiac surgery. Clin J Am Soc Nephrol. 1:19–32PubMedCrossRef
63.
Thakar CV, Arrigain S, Worley S, Yared JP, Paganini EP (2005) A clinical score to predict acute renal failure after cardiac surgery. J Am Soc Nephrol 16:162–168PubMedCrossRef
64.
Moscucci M, Fox KA, Cannon CP et al (2003) Predictors of major bleeding in acute coronary syndromes: the Global Registry of Acute Coronary Events (GRACE). Eur Heart J 24:1815–1823PubMedCrossRef
65.
Eikelboom JW, Mehta SR, Anand SS, Xie C, Fox KA, Yusuf S (2006) Adverse impact of bleeding on prognosis in patients with acute coronary syndromes. Circulation 114:774–782PubMedCrossRef
66.
Latif F, Kleiman NS, Cohen DJ et al (2009) In-hospital and 1-year outcomes among percutaneous coronary intervention patients with chronic kidney disease in the era of drug-eluting stents: a report from the EVENT (Evaluation of Drug Eluting Stents and Ischemic Events) registry. JACC Cardiovasc Interv 2:37–45PubMedCrossRef
67.
Winkelmayer WC, Levin R, Avorn J (2003) Chronic kidney disease as a risk factor for bleeding complications after coronary artery bypass surgery. Am J Kidney Dis 41:84–89PubMedCrossRef
68.
Cadroy Y, Pourrat J, Baladre MF et al (1991) Delayed elimination of enoxaparin in patients with chronic renal insufficiency. Thromb Res 63:385–390PubMedCrossRef
69.
Alexander KP, Chen AY, Roe MT et al (2005) Excess dosing of antiplatelet and antithrombin agents in the treatment of non-ST-segment elevation acute coronary syndromes. JAMA 294:3108–3116PubMedCrossRef
70.
Tsai TT, Maddox TM, Roe MT et al (2009) Contraindicated medication use in dialysis patients undergoing percutaneous coronary intervention. JAMA 302:2458–2464PubMedCrossRef
71.
Hage FG, Venkataraman R, Zoghbi GJ, Perry GJ, DeMattos AM, Iskandrian AE (2009) The scope of coronary heart disease in patients with chronic kidney disease. J Am Coll Cardiol 53:2129–2140PubMedCrossRef
72.
Nakazawa G, Tanabe K, Aoki J et al (2007) Impact of renal insufficiency on clinical and angiographic outcomes following percutaneous coronary intervention with sirolimus-eluting stents. Catheter Cardiovasc Interv 69:808–814PubMedCrossRef
73.
Iakovou I, Schmidt T, Bonizzoni E et al (2005) Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. JAMA 293:2126–2130PubMedCrossRef
74.
Briguori C, Visconti G, Focaccio A et al (2011) Renal Insufficiency After Contrast Media Administration Trial II (REMEDIAL II): RenalGuard System in high-risk patients for contrast-induced acute kidney injury. Circulation 124:1260–1269PubMedCrossRef
75.
Marenzi G, Ferrari C, Marana I et al (2012) Prevention of contrast nephropathy by furosemide with matched hydration. JACC Cardiovasc Interv 5:90–97PubMedCrossRef
76.
Marenzi G, Marana I, Lauri G et al (2003) The prevention of radiocontrast-agent-induced nephropathy by hemofiltration. N Engl J Med 349:1333–1340PubMedCrossRef
77.
Guastoni C, Bellotti N, Poletti F et al (2014) Continuous venovenous hemofiltration after coronary procedures for the prevention of contrast-induced acute kidney injury in patients with severe chronic renal failure. Am J Cardiol 113:588–592PubMedCrossRef
78.
Marenzi G, Mazzotta G, Londrino F et al (2014) Post-procedural hemodiafiltration in acute coronary syndrome patients with associated renal and cardiac dysfunction undergoing urgent and emergency coronary angiography. Catheter Cardiovasc Interv. doi:10.​1002/​ccd.​25694 PubMed
79.
Ranucci M, Ballotta A, Agnelli B et al (2013) Acute kidney injury in patients undergoing cardiac surgery and coronary angiography on the same day. Ann Thorac Surg 95:513–519PubMedCrossRef
80.
Jolly SS, Yusuf S, Cairns J et al (2011) Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. Lancet 377:1409–1420PubMedCrossRef
81.
Ohno Y, Maekawa Y, Miyata H et al (2013) Impact of periprocedural bleeding on incidence of contrast-induced acute kidney injury in patients treated with percutaneous coronary intervention. J Am Coll Cardiol 62:1260–1266PubMedCrossRef
82.
Kooiman J, Seth M, Dixon S et al (2014) Risk of acute kidney injury after percutaneous coronary interventions using radial versus femoral vascular access: insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. Circ Cardiovasc Interv 7:190–198PubMedCrossRef
83.
USRDS (2009) USRDS Annual Report 2009. USRDS, Minneapolis
84.
Black C, Sharma P, Scotland G et al (2010) Early referral strategies for management of people with markers of renal disease: a systematic review of the evidence of clinical effectiveness, cost-effectiveness and economic analysis. Health Technol Assess 14:1–184PubMedCrossRef
85.
Baigent C, Landray M, Leaper C et al (2005) First United Kingdom Heart and Renal Protection (UK-HARP-I) study: biochemical efficacy and safety of simvastatin and safety of low-dose aspirin in chronic kidney disease. Am J Kidney Dis 45:473–484PubMedCrossRef
86.
Best PJ, Steinhubl SR, Berger PB et al (2008) The efficacy and safety of short- and long-term dual antiplatelet therapy in patients with mild or moderate chronic kidney disease: results from the Clopidogrel for the Reduction of Events During Observation (CREDO) trial. Am Heart J 155:687–693PubMedCrossRef
87.
Keltai M, Tonelli M, Mann JF et al (2007) Renal function and outcomes in acute coronary syndrome: impact of clopidogrel. Eur J Cardiovasc Prev Rehabil 14:312–318PubMedCrossRef
88.
James S, Budaj A, Aylward P et al (2010) Ticagrelor versus clopidogrel in acute coronary syndromes in relation to renal function. Results from the platelet inhibition and patient putcomes (PLATO) trial. Circulation 122:1056–1067PubMedCrossRef
89.
Gallieni M, Cozzolino M, Ronga C, Brancaccio D (2008) Low-molecular-weight heparins should be used with caution in patients with chronic kidney disease. Nat Clin Pract Nephrol 4:488–489PubMedCrossRef
90.
Yusuf S, Mehta SR, Chrolavicius S et al (2006) Comparison of fondaparinux and enoxaparin in acute coronary syndromes. N Engl J Med 354:1464–1476PubMedCrossRef
91.
Tomai F, Ribichini F, De Luca L et al (2014) Randomized comparison of Xience V and multi-link vision coronary stents in the same multivessel patient with chronic kidney disease (RENAL-DES) Study. Circulation 129:1104–1112PubMedCrossRef
Metadata
Title
How to balance risks and benefits in the management of CKD patients with coronary artery disease
Authors
Giancarlo Marenzi
Nicola Cosentino
Carlo Guastoni
Publication date
01-08-2015
Publisher
Springer International Publishing
Published in
Journal of Nephrology / Issue 4/2015
Print ISSN: 1121-8428
Electronic ISSN: 1724-6059
DOI
https://doi.org/10.1007/s40620-015-0184-2

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