Treatment of coronary heart disease in end-stage renal disease (dialysis)
- Alfred K Cheung, MD
Alfred K Cheung, MD
- Professor of Medicine
- University of Utah School of Medicine
- William L Henrich, MD, MACP
William L Henrich, MD, MACP
- University of Texas Health Science Center at San Antonio
- Section Editors
- Jeffrey S Berns, MD
Jeffrey S Berns, MD
- Editor-in-Chief — Nephrology
- Section Editor — Dialysis
- Professor of Medicine
- Perelman School of Medicine at the University of Pennsylvania
- Steve J Schwab, MD
Steve J Schwab, MD
- Editor-in-Chief — Nephrology
- Section Editor — Dialysis
- University of Tennessee Health Science Center
- Bernard J Gersh, MB, ChB, DPhil, FRCP, MACC
Bernard J Gersh, MB, ChB, DPhil, FRCP, MACC
- Editor-in-Chief — Cardiovascular Medicine
- Section Editor — Coronary Heart Disease; Myopericardial Disease
- Professor of Medicine
- Mayo Medical School
Cardiovascular disease (CVD) is the single best predictor of mortality in patients with end-stage renal disease (ESRD) as it accounts for almost 50 percent of deaths [1-4]. Of the cardiovascular deaths, approximately 20 percent can be attributed to the consequences of coronary heart disease (CHD). Patients with varying degrees of chronic kidney disease (CKD), but not yet dialysis dependent, also have a markedly increased risk of morbidity and mortality from CVD, including CHD. (See "Patient survival and maintenance dialysis" and "Chronic kidney disease and coronary heart disease".)
Most of the issues relating to CHD are similar in patients with and without renal failure. This topic review will emphasize those features of the treatment of CHD that distinguish the dialysis patient from those without kidney disease. Related issues, such as secondary prevention and diagnosis of CHD in dialysis patients, are presented separately. (See "Clinical manifestations and diagnosis of coronary heart disease in end-stage renal disease (dialysis)" and "Risk factors and epidemiology of coronary heart disease in end-stage renal disease (dialysis)" and "Secondary prevention of cardiovascular disease in end-stage renal disease (dialysis)".)
There are two types of angina resulting from CHD, stable and unstable:
●Stable angina refers to chest discomfort that occurs predictably and reproducibly at a certain level of exertion and is relieved with rest or nitroglycerin.
●Unstable angina is an acute coronary syndrome that encompasses a variety of clinical conditions, including the new onset of angina, rest angina, an accelerating pattern of previously stable angina, post-myocardial infarction (MI) angina, and angina after a revascularization procedure. (See "Classification of unstable angina and non-ST elevation myocardial infarction".)
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- PHARMACOLOGIC TREATMENT OF STABLE CORONARY HEART DISEASE
- Antianginal therapy
- Anemia therapy
- Blood pressure control
- Antiplatelet therapy
- Risk factor reduction
- PHARMACOLOGIC TREATMENT OF UNSTABLE CORONARY HEART DISEASE
- Glycoprotein IIb/IIIa inhibitors
- Timing and performance of hemodialysis session
- INVASIVE MANAGEMENT
- Optimal method of coronary revascularization
- Choice of intracoronary stent
- Follow-up issues
- SUMMARY AND RECOMMENDATIONS
- Pharmacologic treatment of stable disease
- Pharmacologic treatment of unstable disease
- Invasive management