TY - JOUR
T1 - Coronary artery disease in dialysis patients: evidence synthesis, controversies and proposed management strategies
AU - Burlacu, A.
AU - Genovesi, S.
AU - Basile, C.
AU - Ortiz, A.
AU - Mitra, S.
AU - Kirmizis, D.
AU - Kanbay, M.
AU - Davenport, A.
AU - van der Sande, F.
AU - Covic, A.
AU - EUDIAL Working Group ERA-EDTA
N1 - Funding Information:
Alexandru Burlacu was supported by the Romanian Academy of Medical Sciences and European Regional Development Fund, MySMIS 107124: Funding Contract 2/Axa 1/31.07.2017/ 107124 SMIS; Adrian Covic was supported by a grant of Ministry of Research and Innovation, CNCS—UEFISCDI, project number PN-III-P4-ID-PCE-2016-0908, contract number 167/2017, within PNCDI III; Alberto Ortiz was supported by PI16/02057, PI19/00588, PI19/00815, DTS18/00032, ERA-PerMed-JTC2018 (KIDNEY ATTACK AC18/00064 and PERSTIGAN AC18/00071, ISCIII-RETIC REDinREN RD016/0009 FEDER funds, Fundacion Renal Iñigo Álvarez de Toledo (FRIAT), Comunidad de Madrid CIFRA2 B2017/BMD-3686.
Publisher Copyright:
© 2020, Italian Society of Nephrology.
PY - 2021/2/1
Y1 - 2021/2/1
N2 - 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.
AB - 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.
KW - acute myocardial-infarction
KW - cardiac troponin
KW - chronic coronary syndrome
KW - chronic kidney disease
KW - chronic kidney-disease
KW - coronary artery disease
KW - dialysis
KW - diastolic function
KW - dual antiplatelet therapy
KW - end-stage renal disease
KW - myocardial infarction
KW - prognostic value
KW - registry annual-report
KW - st-segment elevation
KW - stage renal-disease
KW - united-states
KW - Myocardial infarction
KW - End-stage renal disease
KW - DIASTOLIC FUNCTION
KW - Chronic coronary syndrome
KW - PROGNOSTIC VALUE
KW - DUAL ANTIPLATELET THERAPY
KW - ACUTE MYOCARDIAL-INFARCTION
KW - UNITED-STATES
KW - Chronic kidney disease
KW - Coronary artery disease
KW - REGISTRY ANNUAL-REPORT
KW - CARDIAC TROPONIN
KW - Dialysis
KW - CHRONIC KIDNEY-DISEASE
KW - ST-SEGMENT ELEVATION
KW - STAGE RENAL-DISEASE
U2 - 10.1007/s40620-020-00758-5
DO - 10.1007/s40620-020-00758-5
M3 - (Systematic) Review article
C2 - 32472526
SN - 1121-8428
VL - 34
SP - 39
EP - 51
JO - Journal of Nephrology
JF - Journal of Nephrology
IS - 1
ER -