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Assessment of Vascular Function in Patients With Chronic Kidney Disease
08:50

Assessment of Vascular Function in Patients With Chronic Kidney Disease

Published on: June 16, 2014

Early angiography in patients with chronic kidney disease: a collaborative systematic review

David M Charytan1, Lars Wallentin, Bo Lagerqvist

  • 1Renal Division and Clinical Biometrics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. dcharytan@partners.org

Clinical Journal of the American Society of Nephrology : CJASN
|May 9, 2009
PubMed

Insights

An early invasive strategy using coronary angiography is beneficial for patients with chronic kidney disease (CKD) experiencing acute coronary syndromes. This approach reduces rehospitalization and shows trends toward lower mortality and nonfatal myocardial infarction (MI).

Area of Science:

  • Cardiology
  • Nephrology
  • Clinical Trials & Meta-Analysis

Background:

  • Early invasive strategy with coronary angiography improves outcomes in the general population for unstable angina and non-ST segment elevation myocardial infarction (MI).
  • Effectiveness of early angiography in patients with chronic kidney disease (CKD) remains uncertain.
  • CKD is a significant comorbidity affecting cardiovascular disease management.

Purpose of the Study:

  • To estimate the effectiveness of an early invasive strategy (routine coronary angiography) versus a conservative strategy (selective angiography) in patients with CKD.
  • To analyze outcomes including mortality, nonfatal MI, and rehospitalization in CKD patients undergoing early angiography.

Main Methods:

  • Collaborative meta-analysis of data from identified randomized trials.
  • Inclusion criteria: patients with unstable angina or non-ST MI and estimated glomerular filtration rate (GFR) <60 ml/min per 1.73 m(2).
  • Searched Cochrane, Medline, and EMBASE databases for relevant trials.

Main Results:

  • Included 5 randomized trials with 1453 CKD patients.
  • Early invasive strategy showed nonsignificant reductions in all-cause mortality and nonfatal MI.
  • Significantly reduced rehospitalization rates in the early invasive strategy group.

Conclusions:

  • Benefits of early invasive strategy are preserved in patients with CKD.
  • Early angiography reduces rehospitalization risk and shows trends toward reduced death and nonfatal re-infarction in CKD patients.
  • Coronary angiography should be considered for CKD patients with non-ST elevation acute coronary syndromes.
Abstract

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