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Acute coronary syndromes in patients with renal failure
1Division of Clinical Nutrition and Preventive Medicine, William Beaumont Hospital, 4949 Coolidge, Royal Oak, MI 48073, USA. pmc975@yahoo.com
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Diabetic nephropathy and chronic kidney disease increase cardiac risks, impacting acute coronary syndromes (ACS) outcomes. This review addresses ACS diagnosis and treatment challenges in patients with kidney failure.
Area of Science:
- Nephrology
- Cardiology
- Internal Medicine
Background:
- Rising rates of obesity and diabetes contribute to a secondary epidemic of chronic kidney disease (CKD) and end-stage renal disease (ESRD).
- Cardiovascular disease (CVD) is the primary cause of mortality in patients with CKD.
- Metabolic derangements in renal failure are independent cardiac risk factors, influencing atherosclerosis, acute coronary syndromes (ACS), heart failure, and arrhythmias.
Purpose of the Study:
- To focus on acute coronary syndromes (ACS) in patients with underlying renal failure.
- To highlight key diagnostic and therapeutic challenges in managing ACS in this population.
- To provide an evidence-based approach for this growing patient group, often excluded from clinical trials.
Main Methods:
- Review of existing clinical data sets and literature.
- Analysis of the relationship between estimated glomerular filtration rate (eGFR) and adverse outcomes in ACS.
- Synthesis of information to address diagnostic and treatment considerations.
Main Results:
- An estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m(2) is a powerful predictor of adverse outcomes in ACS.
- Patients with renal disease face unique challenges in the diagnosis and treatment of ACS.
- Lack of inclusion in clinical trials necessitates a data-driven approach from various sources.
Conclusions:
- Renal failure significantly impacts cardiovascular health, particularly in the context of ACS.
- Optimizing the diagnosis and treatment of ACS in patients with CKD is crucial.
- Further research and tailored clinical trial designs are needed for this vulnerable population.
Abstract:
As the rates of obesity and diabetes continue to rise sharply in the United States, there is a secondary epidemic of diabetic nephropathy, chronic kidney disease, and end-stage renal disease requiring renal replacement therapy. Cardiovascular disease is the leading cause of death in patients with renal disease. Many sources of information support the concept that the metabolic condition caused by renal failure is an independent cardiac risk factor with a direct relationship to the pathogenesis of atherosclerosis, acute coronary syndromes (ACS), heart failure, and arrhythmias. An estimated glomerular filtration rate less than 60 mL/min/1.73 m(2) has consistently been shown to be the most powerful predictor of adverse outcomes in ACS. This paper focuses on ACS and highlights the major issues with respect to diagnosis and treatment in patients with underlying renal failure. Because patients with renal disease are routinely excluded from clinical trials of ACS, we draw upon a variety of clinical data sets to gather an evidenced-based approach to this important and growing population of patients.