May 31, 2020

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

Journal of Nephrology
Alexandru BurlacuEUDIAL Working Group of ERA-EDTA

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 dia...Continue Reading

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Mentioned in this Paper

Work-up
Atherosclerosis
Cardiovascular Diseases
Observational Study
Angina Pectoris
Clinical Trials
Anticoagulation Therapy
Complication
Kidney Failure, Chronic
Antiplatelet Therapy

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