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QJM Advance Access originally published online on October 13, 2006
QJM 2006 99(11):723-736; doi:10.1093/qjmed/hcl101
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© The Author 2006. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Review

The treatment of coronary artery disease in patients with chronic kidney disease

N.C. Edwards1, R.P. Steeds2, C.J. Ferro3 and J.N. Townend2

From the 1Department of Cardiovascular Medicine, University of Birmingham, 2Department of Cardiology, Queen Elizabeth Hospital and 3Department of Nephrology, Queen Elizabeth Hospital, Birmingham, UK

Address correspondence to Dr Nicola Edwards, Research Fellow in Cardiology, Department of Cardiovascular Medicine, University of Birmingham, Birmingham, B15 2TT, UK. email: N.C.Edwards{at}bham.ac.uk

Premature cardiovascular disease is the largest cause of mortality, and a major cause of morbidity, in patients with chronic kidney disease (CKD). Patients with end-stage kidney disease (ESKD) are at extreme risk, but cardiovascular event rates are increased even in early CKD. There is little controlled trial evidence on which to base treatment, as most therapeutic trials have excluded CKD patients. Current treatment strategies are therefore based upon small prospective studies or retrospective analyses of controlled trials and registry data. It is thus unclear whether CKD patients benefit from modern secondary preventive treatments in the same manner as patients with normal renal function. There is a need for randomized trials to identify effective drugs to prevent and treat coronary artery disease in CKD. Revascularization by CABG in CKD has been widely reported in registry data to provide better results than medical treatment or angioplasty. Recent angioplasty data in patients with CKD, however, show improving results, and the risks of CABG in CKD remain high. It is not clear which revascularization technique has a better outcome in patients ‘equally suitable’ on angiographic criteria for either procedure. The high rate of late adverse cardiovascular events after both CABG and angioplasty accentuates the need for effective secondary preventive therapy disease in these high-risk patients.


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