title: The management of acute coronary syndromes in patients with chronic kidney disease.
abstract: Coronary heart disease is highly prevalent in patients with CKD, and survival after acute coronary syndrome (ACS) is worse compared with the general population. Many trials that define guidelines for cardiovascular disease excluded patients with kidney disease, leaving a gap between the evidence base and clinical reality. The underlying pathophysiology of vascular disease appears to be different in the setting of CKD. Patients with CKD are more likely to present with myocardial infarction and less likely to be diagnosed with ACS on admission compared with the general population. Patients with CKD appear to benefit with angiography and revascularization compared with medical management alone. However, the increased risk of in-hospital bleeding and risk of contrast-induced acute kidney injury are 2 factors that can limit overall benefit for some. Thus, judicious application of available therapies for the management of ACS is warranted to extend survival and reduce hospitalizations in this high-risk population. In this review, we highlight the clinical challenges and potential solutions for managing ACS in patients with CKD.
authors.affiliation: Division of Nephrology, Duke University Medical Center, Durham, NC; Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX; and The Heart Hospital, Plano, TX. Electronic address: john.roberts@duke.edu.
authors.forename: John K
authors.initials: JK
authors.lastname: Roberts
authors.affiliation: Division of Nephrology, Duke University Medical Center, Durham, NC; Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX; and The Heart Hospital, Plano, TX.
authors.forename: Peter A
authors.initials: PA
authors.lastname: McCullough
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000628:therapy*; D058186:Acute Kidney Injury / Q000139:chemically induced; D003287:Contrast Media / Q000009:adverse effects; D005343:Fibrinolytic Agents / Q000009:adverse effects; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D009204:Myocardial Revascularization; D010348:Patient Care Team; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011859:Radiography; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000628:therapy
chemical_list: D003287:Contrast Media; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors
keywords: Acute coronary syndrome; Bleeding; Chronic kidney disease; Mortality