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Updated: Jul 1, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Management Considerations for Acute Coronary Syndromes in Chronic Kidney Disease
Matthew I Tomey1, Janice Y Chyou2
1Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, 1190 Fifth Avenue, Box 1030, New York, NY, 10029, USA. matthew.tomey@mountsinai.org.
Insights
Patients with chronic kidney disease (CKD) face worse outcomes from acute coronary syndromes (ACS) due to management gaps. Optimizing ACS care in CKD requires addressing underuse of therapies and preventing acute kidney injury.
Area of Science:
- Cardiology
- Nephrology
- Clinical Medicine
Background:
- Patients with chronic kidney disease (CKD) have a higher propensity for adverse outcomes following acute coronary syndromes (ACS).
- Underrepresentation in clinical trials and underuse of evidence-based treatments exacerbate the biological risks associated with CKD in ACS patients.
- Current management strategies for ACS in CKD patients require critical appraisal and optimization.
Purpose of the Study:
- To critically appraise contemporary evidence regarding the management of ACS in patients with CKD.
- To offer practical approaches for clinicians to optimize ACS management in this high-risk population.
- To address the challenges posed by CKD in the context of ACS care.
Main Methods:
- Narrative review of current evidence.
- Analysis of updated multisociety chest pain guidelines.
- Evaluation of evolving tools for predicting and preventing acute kidney injury.
- Assessment of advancements in percutaneous coronary intervention (PCI) and pharmacotherapy.
Main Results:
- Updated guidelines highlight diverse ACS presentations, crucial for CKD patient recognition.
- Improved tools enhance the safety and accessibility of PCI for high-risk CKD patients.
- Advances in radial access, PCI quality, intravascular imaging, and pharmacotherapy are refining risk-benefit assessments for ACS in CKD.
- Key opportunities include reducing underuse of therapies, preventing acute kidney injury, and dedicated research for CKD-specific ACS management.
Conclusions:
- Optimizing ACS management in CKD necessitates addressing underuse of evidence-based therapies and enhancing treatment safety.
- Preventing acute kidney injury is crucial for improving outcomes in CKD patients undergoing ACS interventions.
- Further research specifically investigating ACS management in the context of CKD is essential.
Purpose Of Review:
Propensity of patients with chronic kidney disease (CKD) to adverse outcomes of acute coronary syndromes (ACS) derives, in part, from imperfection in management. Dearth of data resulting from underrepresentation of patients with CKD in ACS trials and underuse of evidence-based testing and therapy compound biological risks inherent to CKD. We sought in this narrative review to critically appraise contemporary evidence and offer suggested approaches to practicing clinicians for the optimization of ACS management in patients with CKD.
Recent Findings:
Updated multisociety chest pain guidelines emphasize the diversity of clinical presentations of ACS, pertinent to recognition of ACS in patients with CKD. Evolving tools to predict and prevent acute kidney injury complicating invasive management of ACS serve to support improved access to and safety of percutaneous coronary intervention (PCI) in CKD patients, who remain at elevated risk. Growth in use of radial access, advances in PCI quality, incorporation of intravascular imaging, and new options and insights in pharmacotherapy contribute to an evolving calculus of ischemic and bleeding risk in ACS with bearing on management in CKD patients. Key opportunities to improve outcomes of ACS for patients with CKD center on avoiding underuse of beneficial medical and invasive therapies; enhancing safety of therapies by leveraging evidence-based strategies to prevent acute kidney injury; and devoting specific effort to investigation of ACS management in the context of CKD.
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