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      Call for Papers: Digital Platforms and Artificial Intelligence in Dementia

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      About Dementia and Geriatric Cognitive Disorders: 2.2 Impact Factor I 4.7 CiteScore I 0.809 Scimago Journal & Country Rank (SJR)

      Call for Papers: Epidemiology of CKD and its Complications

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      The Treatment of Coronary Artery Disease in Patients with Chronic Kidney Disease: Gaps, Challenges, and Solutions

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          Abstract

          Background

          Chronic kidney disease (CKD) is associated with a high burden of coronary artery disease (CAD), which remains the leading cause of death in CKD patients. Despite the high cardiovascular risk, ACS patients with renal dysfunction are less commonly treated with guideline-based medical therapy and are less frequently referred for coronary revascularization.

          Summary

          The management of CAD is more challenging in patients with CKD than in the general population due to concerns regarding side effects and renal toxicity, as well as uncertainty regarding clinical benefit of guideline-based medical therapy and interventions. Patients with advanced CKD and especially those receiving dialysis have not traditionally been represented in randomized trials evaluating either medical or revascularization therapies. Thus, only scant data from small prospective studies or retrospective analyses are available. Recently published studies suggest that there are significant opportunities to substantially improve both cardiovascular and renal outcomes of patients with CAD and CKD, including new medications and interventions. Thus, the objective of this review is to summarize the current evidence regarding the management of CAD in CKD patients, in particular with respect to improvement of both cardiovascular and renal outcomes.

          Key Messages

          Adequate medical therapy and coronary interventions using evidence-based strategies can improve both cardiac and renal outcomes in patients with CAD and CKD.

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          Most cited references73

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          Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes.

          Bernard Zinman, Christoph Wanner, John M. Lachin … (2015)
          The effects of empagliflozin, an inhibitor of sodium-glucose cotransporter 2, in addition to standard care, on cardiovascular morbidity and mortality in patients with type 2 diabetes at high cardiovascular risk are not known.
          Article 0 comments Cited 2888 times – based on 0 reviews     Review now
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            Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction

            John J.V. McMurray, Scott D. Solomon, Silvio E Inzucchi … (2020)
            In patients with type 2 diabetes, inhibitors of sodium-glucose cotransporter 2 (SGLT2) reduce the risk of a first hospitalization for heart failure, possibly through glucose-independent mechanisms. More data are needed regarding the effects of SGLT2 inhibitors in patients with established heart failure and a reduced ejection fraction, regardless of the presence or absence of type 2 diabetes.
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              Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes

              Bruce Neal, Vlado Perkovic, Kenneth Mahaffey … (2017)
              Background Canagliflozin is a sodium-glucose cotransporter 2 inhibitor that reduces glycemia as well as blood pressure, body weight, and albuminuria in people with diabetes. We report the effects of treatment with canagliflozin on cardiovascular, renal, and safety outcomes. Methods The CANVAS Program integrated data from two trials involving a total of 10,142 participants with type 2 diabetes and high cardiovascular risk. Participants in each trial were randomly assigned to receive canagliflozin or placebo and were followed for a mean of 188.2 weeks. The primary outcome was a composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. Results The mean age of the participants was 63.3 years, 35.8% were women, the mean duration of diabetes was 13.5 years, and 65.6% had a history of cardiovascular disease. The rate of the primary outcome was lower with canagliflozin than with placebo (occurring in 26.9 vs. 31.5 participants per 1000 patient-years; hazard ratio, 0.86; 95% confidence interval [CI], 0.75 to 0.97; P<0.001 for noninferiority; P=0.02 for superiority). Although on the basis of the prespecified hypothesis testing sequence the renal outcomes are not viewed as statistically significant, the results showed a possible benefit of canagliflozin with respect to the progression of albuminuria (hazard ratio, 0.73; 95% CI, 0.67 to 0.79) and the composite outcome of a sustained 40% reduction in the estimated glomerular filtration rate, the need for renal-replacement therapy, or death from renal causes (hazard ratio, 0.60; 95% CI, 0.47 to 0.77). Adverse reactions were consistent with the previously reported risks associated with canagliflozin except for an increased risk of amputation (6.3 vs. 3.4 participants per 1000 patient-years; hazard ratio, 1.97; 95% CI, 1.41 to 2.75); amputations were primarily at the level of the toe or metatarsal. Conclusions In two trials involving patients with type 2 diabetes and an elevated risk of cardiovascular disease, patients treated with canagliflozin had a lower risk of cardiovascular events than those who received placebo but a greater risk of amputation, primarily at the level of the toe or metatarsal. (Funded by Janssen Research and Development; CANVAS and CANVAS-R ClinicalTrials.gov numbers, NCT01032629 and NCT01989754 , respectively.).
              Article 0 comments Cited 2098 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Kidney Dis (Basel)
                Journal ID (iso-abbrev): Kidney Dis (Basel)
                Journal ID (hwp): KDD
                Journal ID (publisher-id): KDD
                Title: Kidney Diseases
                Publisher: S. Karger AG (Basel, Switzerland )
                ISSN (Print): 2296-9381
                ISSN (Electronic): 2296-9357
                Publication date (Electronic): 18 October 2023
                Publication date Collection: February 2024
                Volume: 10
                Issue: 1
                Pages: 12-22
                Affiliations
                [a ]Cardiology Department, Meir Medical Center, Kfar Saba, Israel
                [b ]Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
                [c ]Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
                Author notes
                Correspondence to: David Pereg, davidpe@ 123456tauex.tau.ac.il
                Article
                Publisher ID: 533970
                DOI: 10.1159/000533970
                PMC ID: 10843189
                PubMed ID: 38322630
                SO-VID: afa82488-6583-4f43-a337-940b5ddb261c
                Copyright © © 2023 The Author(s). Published by S. Karger AG, Basel
                License:

                This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC) ( http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes requires written permission.

                History
                Date received : 4 January 2023
                Date accepted : 23 August 2023
                Date: 2024
                Page count
                Figures: 1, Tables: 1, References: 73, Pages: 11
                Funding
                No funding was received by the authors.
                Categories
                Subject: Review Article

                Keywords: chronic kidney disease,coronary artery disease,contrast-induced nephropathy,coronary intervention
                Data availability:
                Keywords: chronic kidney disease, coronary artery disease, contrast-induced nephropathy, coronary intervention

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