Coronary artery disease in dialysis patients: evidence synthesis, controversies and proposed management strategies

A. Burlacu, S. Genovesi, C. Basile*, A. Ortiz, S. Mitra, D. Kirmizis, M. Kanbay, A. Davenport, F. van der Sande, A. Covic, EUDIAL Working Group ERA-EDTA

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

2 Citations (Web of Science)

Abstract

Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality among patients with end-stage renal disease (ESRD). Clustering of traditional atherosclerotic and non-traditional risk factors drive the excess rates of coronary and non-coronary CVD in this population. The incidence, severity and mortality of coronary artery disease (CAD) as well as the number of complications of its therapy is higher in dialysis patients than in non-chronic kidney disease patients. Given the lack of randomized clinical trial evidence in this population, current practice is informed by observational data with a significant potential for bias. Furthermore, guidelines lack any recommendation for these patients or extrapolate them from trials performed in non-dialysis patients. Patients with ESRD are more likely to be asymptomatic, posing a challenge to the correct identification of CAD, which is essential for appropriate risk stratification and management. This may lead to "therapeutic nihilism", which has been associated with worse outcomes. Here, the ERA-EDTA EUDIAL Working Group reviews the diagnostic work-up and therapy of chronic coronary syndromes, unstable angina/non-ST elevation and ST-elevation myocardial infarction in dialysis patients, outlining unclear issues and controversies, discussing recent evidence, and proposing management strategies. Indications of antiplatelet and anticoagulant therapies, percutaneous coronary intervention and coronary artery bypass grafting are discussed. The issue of the interaction between dialysis session and myocardial damage is also addressed.
Original languageEnglish
Pages (from-to)39-51
Number of pages13
JournalJournal of Nephrology
Volume34
Issue number1
DOIs
Publication statusPublished - 1 Feb 2021

Keywords

  • acute myocardial-infarction
  • cardiac troponin
  • chronic coronary syndrome
  • chronic kidney disease
  • chronic kidney-disease
  • coronary artery disease
  • dialysis
  • diastolic function
  • dual antiplatelet therapy
  • end-stage renal disease
  • myocardial infarction
  • prognostic value
  • registry annual-report
  • st-segment elevation
  • stage renal-disease
  • united-states
  • Myocardial infarction
  • End-stage renal disease
  • DIASTOLIC FUNCTION
  • Chronic coronary syndrome
  • PROGNOSTIC VALUE
  • DUAL ANTIPLATELET THERAPY
  • ACUTE MYOCARDIAL-INFARCTION
  • UNITED-STATES
  • Chronic kidney disease
  • Coronary artery disease
  • REGISTRY ANNUAL-REPORT
  • CARDIAC TROPONIN
  • Dialysis
  • CHRONIC KIDNEY-DISEASE
  • ST-SEGMENT ELEVATION
  • STAGE RENAL-DISEASE

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