Diagnosis and therapy of coronary artery disease in renal failure, end-stage renal disease, and renal transplant populations.
Even though cardiovascular disease is the leading cause of death in patients with CRF and end-stage renal disease (ESRD), ill-conceived notions have led to therapeutic nihilism as the predominant strategy in the management of cardiovascular disease in these populations. The recent data clearly support the application of proven interventions in the general population, such as angiotensin-converting enzyme inhibitors and statins to patients with CRF and ESRD. The advances in coronary stents and intracoronary irradiation have decreased the restenosis rates in renal failure patients. Coronary artery bypass with internal mammary graft might be the procedure of choice for coronary revascularization in these patients. The role of screening for asymptomatic coronary disease is established as a pretransplant procedure, but it is unclear whether this will be applicable to all patients with ESRD. Future studies need to focus on unraveling the mechanisms by which uremia leads to increased cardiovascular events to design optimal therapies targeted toward these mechanisms and improve cardiovascular outcomes.
Logar
Christine M
CM
Renal Section, Salt Lake VA Healthcare System, Department of Medicine, University of Utah School of Medicine, Salt Lake City, USA.
Herzog
Charles A
CA
Beddhu
Srinivasan
S
D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002118:Calcium / Q000378:metabolism; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000188:drug therapy*; D006710:Homocysteine / Q000378:metabolism; D006801:Humans; D007249:Inflammation / Q000378:metabolism; D007676:Kidney Failure, Chronic / Q000503:physiopathology* / Q000601:surgery; D016030:Kidney Transplantation; D050356:Lipid Metabolism; D009204:Myocardial Revascularization; D009747:Nutritional Physiological Phenomena; D018384:Oxidative Stress; D010281:Parathyroid Hormone / Q000378:metabolism; D051437:Renal Insufficiency / Q000503:physiopathology*; D012307:Risk Factors; D014807:Vitamin D / Q000378:metabolism
D000959:Antihypertensive Agents; D010281:Parathyroid Hormone; D006710:Homocysteine; D014807:Vitamin D; D002118:Calcium