[Cardiovascular pharmacotherapy and coronary revascularization in end-stage renal failure]

Area of Science:

• Nephrology
• Cardiology
• Internal Medicine

Background:

• A strong physiological link exists between kidney and heart health.
• Cardiovascular diseases (CVD) are the leading cause of mortality in chronic kidney disease (CKD) patients.
• CKD is recognized as an independent cardiovascular risk factor, potentially accelerating CVD progression.

Purpose of the Study:

• To highlight the treatment challenges for cardiovascular diseases in patients with advanced CKD.
• To emphasize the need for evidence-based guidelines for managing coronary artery disease and heart failure in CKD.
• To call for prospective randomized studies focusing on patients with impaired renal function.

Main Methods:

• Review of existing literature on the relationship between CKD and cardiovascular diseases.
• Analysis of treatment recommendations for coronary artery disease and heart failure in CKD patients.
• Identification of gaps in evidence due to exclusion of advanced CKD patients from pivotal trials.

Main Results:

• Treatment for mild CKD patients (eGFR >60 ml/min/1.73 m²) with cardiovascular disease is similar to those with normal renal function.
• Treatment guidelines for advanced CKD patients are often based on observational data, subgroup analyses, and pathophysiological reasoning, not controlled trials.
• Pivotal clinical trials have largely excluded individuals with advanced renal failure, limiting evidence for this population.

Conclusions:

• Current treatment strategies for cardiovascular diseases in advanced CKD are not robustly supported by controlled studies.
• There is a critical need for prospective randomized trials to establish effective management protocols for heart failure and coronary artery disease in patients with advanced CKD.
• Addressing the cardiovascular risks in CKD requires dedicated research focusing on patients with significant renal impairment.