Related Experiment Video

Updated: Nov 15, 2025

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

16.5K

Medical Therapy Versus Revascularization in Patients with Stable Ischemic Heart Disease and Advanced Chronic Kidney

Timir K Paul1, Mamas A Mamas2,3, Madhan Shanmugasundaram4

  • 1Department of Medicine, Division of Cardiology, East Tennessee State University, 329 N State of Franklin Rd, Johnson City, TN, 37604, USA. pault@etsu.edu.

Current Cardiology Reports
|March 3, 2021
PubMed

Insights

For stable ischemic heart disease (SIHD) patients with advanced chronic kidney disease (CKD), optimal medical therapy (OMT) shows similar outcomes to revascularization. Revascularization does not improve mortality, heart attacks, or angina relief in this high-risk group.

Area of Science:

  • Cardiology
  • Nephrology
  • Clinical Trials

Background:

  • Stable ischemic heart disease (SIHD) and advanced chronic kidney disease (CKD) represent a complex comorbidity.
  • Optimal medical therapy (OMT) is the cornerstone of SIHD management, but its role relative to revascularization in CKD patients is debated.

Purpose of the Study:

  • To review current evidence comparing OMT with coronary revascularization in patients with SIHD and advanced CKD.
  • To evaluate the impact of invasive versus conservative strategies on clinical outcomes and symptoms in this population.

Main Methods:

  • Analysis of post hoc data from the COURAGE trial for SIHD patients with CKD.
  • Inclusion of data from the ISCHEMIA-CKD trial, a randomized controlled trial involving 777 patients with advanced CKD.

Main Results:

  • No significant difference in angina, death, or myocardial infarction (MI) between OMT and revascularization in SIHD patients with CKD (COURAGE trial).
  • ISCHEMIA-CKD trial showed no difference in death or MI at 3 years, but a higher rate of death or new dialysis with revascularization.
  • No sustained benefits in angina-related health status were observed with an invasive strategy compared to OMT.

Conclusions:

  • An initial revascularization strategy does not reduce mortality, MI, or improve angina symptoms in patients with SIHD and advanced CKD.
  • Optimal medical therapy (OMT) appears to be a safe and effective strategy for managing SIHD in patients with advanced CKD.
Abstract

Keywords:
Advanced chronic kidney diseaseCoronary artery bypass graftOptimal medical therapyPercutaneous coronary interventionRevascularizationStable ischemic heart disease

More Related Videos

5/6 Nephrectomy Using Sharp Bipolectomy Via Midline Laparotomy in Rats05:34

5/6 Nephrectomy Using Sharp Bipolectomy Via Midline Laparotomy in Rats

Published on: April 4, 2025

1.1K
Intravascular Delivery of Biologics to the Rat Kidney07:29

Intravascular Delivery of Biologics to the Rat Kidney

Published on: September 1, 2016

7.9K

Related Concept Videos

Chronic Kidney Disease III: Interprofessional Care01:28

Chronic Kidney Disease III: Interprofessional Care

Chronic kidney disease (CKD) requires collaborative and comprehensive management. CKD progresses through stages and can lead to end-stage kidney disease (ESKD) if untreated. Interprofessional collaboration and patient education are crucial, enabling patients to manage their health and improve their quality of life.Diagnostic approach for chronic kidney diseaseThe diagnosis of CKD primarily focuses on the glomerular filtration rate (GFR), which assesses kidney function by measuring how well...
199
Coronary Artery Disease V: Interprofessional Care01:27

Coronary Artery Disease V: Interprofessional Care

Interprofessional care for coronary artery disease includes pharmacological therapy and revascularization procedures.Pharmacological therapy for Coronary Artery Disease (CAD) aims to manage symptoms, prevent complications, and improve patient outcomes through various classes of medications:Antiplatelet Agents:Aspirin and Clopidogrel: These medications inhibit platelet aggregation, preventing blood clots, which is crucial for avoiding heart attacks and strokes. Doctors often prescribe these...
121
Heart Failure V: Medical Management01:30

Heart Failure V: Medical Management

Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
85
Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System

The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
666
Kidney Transplant I: Introduction01:28

Kidney Transplant I: Introduction

A kidney transplant is a surgical approach that involves replacing a non-functioning kidney with a healthy one from a donor. This procedure is often a treatment option for end-stage renal disease (ESRD) patients. The method requires careful recipient selection, including evaluating various medical and psychosocial factors. These criteria vary between transplant centers but generally include assessments of the patient's overall health, adherence to medical recommendations, and lifestyle...
147
Acute Kidney Injury IV: Diagnostic Studies and Prevention01:30

Acute Kidney Injury IV: Diagnostic Studies and Prevention

Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
137