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Revascularization options in patients with chronic kidney disease Ashrith G; Elayda MA; Wilson JMTex Heart Inst J 2010[]; 37 (1): 9-18Cardiovascular disease is the leading cause of death in patients who have chronic kidney disease or end-stage renal disease and are undergoing hemodialysis. Chronic kidney disease is a recognized risk factor for premature atherosclerosis. Unfortunately, most major randomized clinical trials that form the basis for evidence-based use of revascularization procedures exclude patients who have renal insufficiency. Retrospective, observational studies suggest that patients with end-stage renal disease and severe coronary occlusive disease have a lower risk of death if they undergo coronary revascularization rather than medical therapy alone. Due to a lack of prospective studies, however, the relative merits of percutaneous versus surgical revascularization are merely a matter of opinion. Several small, retrospective studies have shown that coronary artery bypass grafting is associated with higher procedural death but better long-term survival than is percutaneous coronary intervention. This difference appears to result from poor long-term results of percutaneous coronary intervention in patients who have chronic kidney disease or end-stage renal disease.Because randomized trials comparing percutaneous coronary intervention and coronary artery bypass grafting have included patients undergoing balloon angioplasty and placement of bare-metal stents, their conclusions are suspect in the era of drug-eluting stents. In this review, we discuss different revascularization options for patients with chronic kidney disease, the outcomes of revascularization procedures, and the risk factors for adverse outcomes.|*Renal Dialysis[MESH]|Angioplasty, Balloon, Coronary[MESH]|Cardiovascular Diseases/etiology/mortality[MESH]|Coronary Artery Bypass[MESH]|Coronary Artery Bypass, Off-Pump[MESH]|Coronary Artery Disease/complications/mortality/*therapy[MESH]|Humans[MESH]|Kidney Failure, Chronic/complications/mortality/*therapy[MESH]|Myocardial Revascularization/adverse effects/*methods/mortality[MESH]|Patient Selection[MESH]|Risk Assessment[MESH]|Risk Factors[MESH]|Time Factors[MESH]|Treatment Outcome[MESH] |
