Current status of prevention, diagnosis, and management of coronary artery disease in patients with kidney failure

Abstract

Background Patients with kidney failure have a heavy burden of coronary artery disease. The results of preventive, diagnostic, and therapeutic measures developed in nonuremic populations cannot automatically be extrapolated to this unique group of patients. Methods and Results Articles were reviewed if they contained English language text or an abstract identified by MEDLINE search from 1980 to 1999, supplemented by manual review of bibliographies of published articles and abstract issues of national cardiology meetings, studies on diagnostic techniques, risk modification measures, pharmacologic agents, and coronary revascularization procedures in patients with uremia. Descriptive and quantitative data as appropriate were extracted. Lipid-lowering agents may be safely administered to uremic patients. Direct evidence of lipid lowering in this population is not available and is not likely to be forthcoming. Erythropoietin therapy is effective in reversing the cardiovascular perturbations of uremic anemia, but an approach of normalizing the hematocrit cannot be recommended. Glycoprotein IIb/IIIa inhibitors used in acute coronary syndromes require downward dose adjustment or are contraindicated. Thrombolytic agents are underutilized in the management of myocardial infarction. Noninvasive testing is less accurate than in nonuremic populations. Coronary revascularization offers relative clinical advantages over medical therapy similar to non–kidney failure populations, even though the results in uremic patients is significantly less favorable than for nonuremic patients. Stenting is the preferred revascularization approach, and conventional balloon percutaneous transluminal coronary angioplasty the least favorable. Conclusions Many but not all of the benefits of therapies developed in nonuremic patients extend to patients with kidney failure. Physicians should be familiar with the advantages and limitations of each of these modalities in this population. (Am Heart J 2000;139:1000-8.)