Coronary artery disease and percutaneous coronary intervention in patients with severe chronic kidney disease

Area of Science:

• Cardiology
• Nephrology
• Interventional Cardiology

Background:

• Coronary artery disease (CAD) is a major cause of death in chronic kidney disease (CKD) patients.
• CKD patients often have atypical CAD symptoms and face procedural risks like contrast-induced nephropathy.
• The fear of renal injury can lead to delayed necessary interventions, termed 'renalism'.

Purpose of the Study:

• To review the challenges of diagnosing and managing CAD in CKD patients.
• To explore the limitations of traditional diagnostic and interventional methods.
• To introduce emerging contrast-sparing techniques for CAD management in CKD.

Main Methods:

• Review of current literature on CAD in CKD.
• Discussion of clinical presentations and diagnostic limitations.
• Overview of ultra-low contrast angiography (ULCA) and zero-contrast percutaneous coronary intervention (PCI).

Main Results:

• ULCA and zero-contrast PCI demonstrate safety and feasibility, even in complex cases.
• These techniques minimize or eliminate contrast exposure, reducing renal risks.
• Emerging contrast-sparing methods show promise for high-risk CKD patients.

Conclusions:

• Zero-contrast PCI is a potentially essential strategy for revascularization in high-risk CKD patients.
• These techniques enhance procedural safety while maintaining therapeutic effectiveness.
• Advancements in contrast-sparing interventions are crucial for improving CAD management in CKD.