Management of Coronary Disease in Patients with Advanced Kidney Disease

Bangalore, Sripal; Maron, David J.; O’Brien, Sean M.; Fleg, Jerome L.; Kretov, Еvgeny; Briguori, Carlo; Kaul, Upendra; Reynolds, Harmony R.; Mazurek, Tomasz; Sidhu, Mandeep S.; Berger, Jeffrey S.; Mathew, Roy; Bockeria, O.L.; Broderick, Samuel; Pracoń, Radosław; Herzog, Charles A.; Huang, Zhen; Stone, Gregg W.; Boden, William E.; Newman, Jonathan; Ali, Ziad A.; Mark, Daniel B.; Spertus, John A.; Alexander, Karen P.; Chaitman, Bernard R.; Chertow, Glenn M.; Hochman, Judith S.

doi:10.1056/nejmoa1915925

Cited by 337 publications

(315 citation statements)

References 19 publications

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“…Many studies have confirmed that comorbidities are important risk factors for the severity and outcome of SARS-CoV-2 infection [ 1 ]. Chronic kidney disease (CKD) [ 2 ] is not uncommon and represents one of the chronic diseases witnessed during COVID-19 ranging from 8.5 to 9.8% so far reported [ 3 ]. In this article, we reviewed the impact of SARS-CoV-2 infection in disease progression and outcome in CKD patients and relevant interests or topics.…”

Section: Introductionmentioning

confidence: 99%

SARS-CoV-2-Related Kidney Injury: Current Concern and Challenges

Cheng

Wang

et al. 2020

SN Compr. Clin. Med.

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Coronavirus disease 2019 (COVID-19) not only causes pulmonary inflammation but also causes multiple organ damages, including the kidney. ACE2, as one of the receptors for SARS-CoV-2 intrusion, is widely distributed in kidney tissues. Currently, the diagnosis and treatment of SARS-CoV-2 infection in patients with chronic kidney disease (CKD) are still unclear. Here, we review the recent findings of characteristics of COVID-19 in CKD patients and highlight the possible mechanisms of kidney injury caused by SARS-CoV-2 infection. We then discuss the emerging therapeutic approaches aimed at reducing kidney damage and protecting kidney function including virus removal, immunotherapy, supporting treatment, special blood purification therapy, etc. Problems unresolved and challenges ahead are also discussed.

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Section: Introductionmentioning

confidence: 99%

SARS-CoV-2-Related Kidney Injury: Current Concern and Challenges

Cheng

Wang

et al. 2020

SN Compr. Clin. Med.

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“…mit Niereninsuffizienz zu einer signifikanten Reduktion der Rate klinischer Ereignisse führt im Vergleich zur konservativen (optimal-medikamentösen) Therapie [2 -5]. Eine Reduktion von ischämischen kardiovaskulären Ereignissen oder Tod konnte durch die frühzeitige Revaskularisierung im Vergleich zur medikamentösen Therapie allerdings nicht nachgewiesen werden [2,3]. Zumindest konnte aber ein gewisser Nutzen in Bezug auf die Lebensqualität in Patienten im Interventionsarm (ohne Niereninsuffizienz) ermittelt werden [5] [17].…”

Section: Introductionunclassified

Chronisches Koronarsyndrom – optimale medikamentöse Therapie

Totzeck

Rassaf

2020

Aktuelle Kardiologie

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ZusammenfassungDer Begriff „chronisches Koronarsyndrom“ ersetzt mit den aktuellen Leitlinien der Europäischen Gesellschaft für Kardiologie (ESC) die Begrifflichkeit der sogenannten „stabilen koronaren Herzerkrankung (KHK)“. Hierdurch werden insbesondere die chronisch-progredienten Eigenschaften der KHK betont. Die medikamentöse Therapie des chronischen Koronarsyndroms zielt auf die Minimierung der Ereignisraten und Symptomprogredienz ab. Zu den wesentlichen Säulen dieser medikamentösen Therapie zählen die Antianginosa (u. a. Betablocker, Kalziumantagonisten, organische Nitrate), die verschiedenen Plättchenaggregationsregime, Lipidsenker sowie Modulatoren des Renin-Angiotensin-Aldosteron-Systems. Eine sogenannte allgemeingültige „optimale Therapie“ ist schwierig zu definieren, daher gilt es, individuell für jeden Patienten die bestmögliche Therapie und Symptomkontrolle anhand dieser Leitlinienempfehlungen zu definieren und nach Bedarf anzupassen.

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“…The identi cation of patients at higher risk of CI-AKI prior to PCI is challenging, but necessary. In stable coronary artery disease, the potential advantages of PCI need to be weighed against the risk of renal insu ciency (8). In the setting of acute coronary syndromes, the risk of CI-AKI may provide indications when planning the extent of the revascularization to be achieved (9).…”

Section: Introductionmentioning

confidence: 99%

Adding Pre-procedural Glycemia to the Mehran Score Enhances Its Ability to Predict Contrast-induced Acute Kidney Injury in Patients With and Without Diabetes Undergoing Percutaneous Coronary Intervention

Nusca¹,

Mangiacapra²,

Sticchi³

et al. 2020

Preprint

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Background: The Mehran score is the most widely accepted tool for predicting contrast-induced acute kidney injury (CI-AKI), a major complication of percutaneous coronary intervention (PCI). Similarly, abnormal fasting pre-procedural glycemia (FPG) represents a modifiable risk factor for CI-AKI, but it is not included in current risk models for CI-AKI prediction. We sought to analyze whether adding FPG to the Mehran score improves its ability to predict CI-AKI following PCI.Methods: We analyzed 671 consecutive patients undergoing PCI (age 69 [63,75] years, 23% females), regardless of their diabetic status, to derive a revised Mehran score obtained by including FPG in the original Mehran score (Derivation Cohort). The new risk model (GlyMehr) was externally validated in 673 consecutive patients (Validation Cohort) (age 69 [62,76] years, 21% females). Results: In the Derivation Cohort, both FPG and the original Mehran score predicted CI-AKI (AUC 0.703 and 0.673, respectively). The GlyMehr score showed a better predictive ability when compared with the Mehran score both in the Derivation Cohort (AUC 0.749, 95%CI 0.662-0.836; p=0.0016) and the Validation Cohort (AUC 0.848, 95%CI, 0.792–0.903; p=0.0008). In the overall population (n=1344), the GlyMehr score confirmed its independent and incremental predictive ability regardless of diabetic status (p≤0.0034) or unstable/stable coronary syndromes (p≤0.0272). Conclusions: Adding FPG to the Mehran score significantly enhances our ability to predict CI-AKI. The GlyMehr score may contribute to improve the clinical management of patients undergoing PCI by identifying those at high risk of CI-AKI and potentially detecting modifiable risk factors.

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Management of Coronary Disease in Patients with Advanced Kidney Disease

Cited by 337 publications

References 19 publications

SARS-CoV-2-Related Kidney Injury: Current Concern and Challenges

SARS-CoV-2-Related Kidney Injury: Current Concern and Challenges

Chronisches Koronarsyndrom – optimale medikamentöse Therapie

Adding Pre-procedural Glycemia to the Mehran Score Enhances Its Ability to Predict Contrast-induced Acute Kidney Injury in Patients With and Without Diabetes Undergoing Percutaneous Coronary Intervention

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