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STATE-OF-THE-ART PAPER

The renal patient with coronary artery disease

Current concepts and dilemmas

Cardiology Division, University of Texas Medical Branch, Galveston, Texas

Manuscript received February 3, 2004; revised manuscript received June 21, 2004, accepted June 22, 2004.

^* Reprint requests and correspondence: Dr. Barry F. Uretsky, University of Texas Medical Branch at Galveston, Department of Internal Medicine, 5.106 John Sealy Annex, 301 University Boulevard, Galveston, Texas 77555-0553 (Email: buretsky{at}utmb.edu).

The patient with chronic kidney disease and coronary artery disease (CAD) presents special challenges. This report reviews the scope of the challenge, the hostile internal milieu predisposing to CAD and cardiac events, management issues, unresolved dilemmas, and the need for randomized trials to allow for evidence-based treatment.

Abbreviations and Acronyms   ACEI = angiotensin-converting enzyme inhibitors   ACS = acute coronary syndrome   AMI = acute myocardial infarction   CABG = coronary artery bypass graft surgery   CAD = coronary artery disease   CCr = creatinine clearance   CIN = contrast-induced nephropathy   CKD = chronic kidney disease   CK-MB = creatine kinase-myocardial band   DM = diabetes mellitus   ESRD = end-stage renal disease   GFR = glomerular filtration rate   HD = hemodialysis   PCI = percutaneous coronary intervention   RR = risk ratio   RTR = renal transplant recipient   sCr = serum creatinine

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