Rational Pharmacotherapy in Cardiology

Advanced search


Full Text:


The ischemic heart disease (IHD) with comorbid kidney dysfunction has more severe course and worse prognosis, regardless of the chosen therapeutic strategy for the treatment of coronary disease. Traits of diagnosis and treatment of IHD in patients with renal dysfunction, including end-stage kidney disease, are discussed. The analysis of the studies showed increasing difficulties in the diagnosis of IHD, and decrease in the effectiveness of drug and invasive treatment.

Results of large randomized and observational studies can help to treat patients with IHD and comorbid renal dysfunction more effectively and safe. 

About the Author

F. I. Belyalov
Irkutsk State Medical Academy of Postgraduate Education
Russian Federation

Farid I. Belyalov - MD, PhD, Professor, Chair of Gerontology & Geriatrics, Head of Cardiac Arrhythmia Centre

Yubileinii mkrn100, Irkutsk, 664079


1. Belyalov F.I. Treatment of diseases in conditions of comorbidity. 10th ed. Moscow: GEOTAR-Media; 2016. (In Russ.) [Белялов Ф.И. Лечение болезней в условиях коморбидности. Изд. 10-е. Москва: ГЭО-ТАР-Медиа; 2016].

2. Herzog C.A., Asinger R.W., Berger A.K., et al. Cardiovascular disease in chronic kidney disease. A clinical update from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int. 2011;80(6): 572-86.

3. Brugts J.J., Boersma E., Chonchol M., et al. The Cardioprotective Effects of the Angiotensin-Converting Enzyme Inhibitor Perindopril in Patients With Stable Coronary Artery Disease Are Not Modified by Mild to Moderate Renal Insufficiency. J Am Coll Cardiol. 2007;50:2148-55.

4. United States Renal Data System. Renal Data SystemChapter 4: Cardiovascular Disease in Patients With CKD. Am J Kidn Dis. 2016;67(3):S49-S56.

5. Khalique O., Aronow W.S., Ahn C., et al. Relation of Moderate or Severe Reduction in Glomerular Filtration Rate to Number of Coronary Arteries Narrowed >50% in Patients Undergoing Coronary Angiography for Suspected Coronary Artery Disease. Am J Cardiol. 2007;100:415-6.

6. Toshiaki N., Toshiharu N., Shinji S., et al. Association of Kidney Function With Coronary Atherosclerosis and Calcification in Autopsy Samples From Japanese Elders: The Hisayama Study. American Journal of Kidney Diseases. 2010;55(10):21-30.

7. Sedlis S.P., Jurkovitz C.T., Hartigan P.M., et al. Optimal medical therapy with or without percutaneous coronary intervention for patients with stable coronary artery disease and chronic kidney disease. Am J Cardiol. 2009; 104: 1647-53.

8. Tonelli M., Muntner P., Lloyd A., et al. Risk of coronary events in people with chronic kidney disease compared with those with diabetes: a population-level cohort study. Lancet. 2012;380(9844): 807-14.

9. Cai Q., Mukku V.K., Ahmad M. Coronary artery disease in patients with chronic kidney disease: a clinical update. Curr Cardiol Rev. 2013;9(4):331-9.

10. Blankestijn P.J. Sympathetic hyperactivity in chronic kidney disease. Nephrol Dial Transplant. 2004;19:1354-7.

11. Koomans H.A., Blankestijn P.J., Joles J.A. Sympathetic Hyperactivity in Chronic Renal Failure: A Wake-up Call. J Am Soc Nephrol. 2004;15:524-37.

12. Bakris G.L., Hart P., Ritz E., et al. Beta blockers in the management of chronic kidney disease. Kidney International 2006;70:1905-13.

13. Charytan D.M., Shelbert H.R., Di Carli M.F. Coronary microvascular function in early chronic kidney disease. Circ Cardiovasc Imaging. 2010;3(6):663-71.

14. Mohandas R., Segal M.S., Huo T., et al. Renal function and coronary microvascular dysfunction in women with symptoms/signs of ischemia. PLoS One. 2015;10(5):e0125374.

15. Hayano S., Ichimiya S., Ishii H., et al. Relation Between Estimated Glomerular Filtration Rate and Composition of Coronary Arterial Atherosclerotic Plaques. The American Journal of Cardiology. 2012;109(8):1131-6.

16. Charytan D.M., Stern N.M., Mauri L. CKD and Coronary Collateral Supply in Individuals Undergoing Coronary Angiography after Myocardial Infarction. Clin J Am Soc Nephrol. 2012;7(7):1079-86.

17. Liu H., Yan L., Ma G.S., et al. Association of chronic kidney disease and coronary artery disease in 1,010 consecutive patients undergoing coronary angiography. J Nephrol. 2012;25(2):219-24.

18. Covic A., Kothawala P., Bernal M., et al. Systematic review of the evidence underlying the association between mineral metabolism disturbances and risk of all-cause mortality, cardiovascular mortality and cardiovascular events in chronic kidney disease. Nephrol Dial Transplant. 2009;24(5): 1506-23.

19. Waldeyer C., Karakas M., Scheurle C., et al. The predictive value of different equations for estimation of glomerular filtration rate in patients with coronary artery disease — Results from the AtheroGene study. Int J Card. 2016;221:908-13.

20. Parsh J., Seth M., Aronow H., et al. Choice of Estimated Glomerular Filtration Rate Equation Impacts Drug-Dosing Recommendations and Risk Stratification in Patients With Chronic Kidney Disease Undergoing PCI. J Am Coll Cardiol. 2015;65(25):2714-23.

21. Wetmore J.B., Broce M., Malas A., Almehmi A. Painless Myocardial Ischemia Is Associated with Mortality in Patients with Chronic Kidney Disease. Nephron Clinical Practice. 2012;122(1-2):9-16

22. Go A.S., Bansal N., Chandra M. et al. Chronic Kidney Disease and Risk for Presenting With Acute Myocardial Infarction Versus Stable Exertional Angina in Adults With Coronary Heart Disease. J Am Coll Cardiol. 2011;58(15):1600-7.

23. Silver S.A., Shah P.M., Chertow G.M., et al. Risk prediction models for contrast induced nephropathy: systematic review. BMJ. 2015;351.

24. Liu Y., Liu Y., Zhou Y., et al. Comparison of Different Risk Scores for Predicting Contrast Induced Nephropathy and Outcomes After Primary Percutaneous Coronary Intervention in Patients With STEMI. Am J Card. 2016;117(12):1896-903.

25. Subramaniam R.M., Suarez-Cuervo C., Wilson R.F., et al. Effectiveness of Prevention Strategies for Contrast-Induced Nephropathy: A Systematic Review and Meta-analysis. Ann Intern Med. 2016;164:406-16.

26. Solomon R.J., Natarajan M.K., Doucet S., et al. Cardiac Angiography in Renally Impaired Patients (CARE) Study: A Randomized Double-Blind Trial of Contrast-Induced Nephropathy in Patients With Chronic Kidney Disease. Circulation. 2007;115:3189-96.

27. Leoncini M., Toso A., Maioli M., et al. Early high-dose rosuvastatin and cardioprotection in the Protective effect of Rosuvastatin and Antiplatelet Therapy On contrast-induced acute kidney injury and myocardial damage in patients with ACS study. Am Heart J. 2014;168:792-797

28. Khatri M., Moon Y.P., Scarmeas N. et al. The Association between a Mediterranean-Style Diet and Kidney Function in the Northern Manhattan Study Cohort. Clinical Journal of the American Society of Nephro-ogy. 2014;9:1868-75.

29. Diaz-Lopez A., Bullo M., Martinez-Gonzalez M.A., Guasch-Ferre M. et al. Effects of Mediterranean Diets on Kidney Function: A Report From the PREDIMED Trial. Am J Kidney Dis. 2012;60(3): 380-9.

30. Charytan D., Kuntz R.E. The exclusion of patients with chronic kidney disease from clinical trials in coronary artery disease. Kidney International. 2006;70:2021-30.

31. Coca S.G., Krumholz H.M., Garg A.X., et al. Underrepresentation of Renal Disease in Randomized Controlled Trials of Cardiovascular Disease. JAMA 2006;296:1377-84.

32. Sedlis S.P., Jurkovitz C.T., Hartigan P.M., et al. Health Status and Quality of Life in Patients With Stable Coronary Artery Disease and Chronic Kidney Disease Treated With Optimal Medical Therapy or Percutaneous Coronary Intervention. The American Journal of Cardiology. 2013;112:1703-8.

33. Gottlieb S.S., McCarter R.J., Vogel R.A. et al. Effect of Beta-Blockade on Mortality among High-Risk and Low-Risk Patients after Myocardial Infarction. N Engl J Med .1998;339:489-97.

34. Fleet J.L., Weir M.A., McArthur E. et al. Kidney Function and Population-Based Outcomes of Initiating Oral Atenolol Versus Metoprolol Tartrate in Older Adults.American Journal of Kidney Diseases. 2014;64:883-91.

35. Nowicki M., Miszczak-Kuban J. Nonselective Beta-adrenergic blockade augments fasting hyperkalemia in hemodialysis patients. Nephron. 2002;91(2):222-7.

36. Griffin K.A., Bidani A.K. Potential risks of calcium channel blockers in chronic kidney disease. Curr Cardiol Rep. 2008;10(6):448-55.

37. Koren M.J., Davidson M.H., Wilson D.J., et al. Focused Atorvastatin Therapy in Managed-Care Patients With Coronary Heart Disease and CKD. Am J Kidney Dis. 2009;53:741-50.

38. Dasari T.W., Cohen D.J., Kleiman N.S., et al. Statin Therapy in Patients With Chronic Kidney Disease Undergoing Percutaneous Coronary Intervention. The American Journal of Cardiology. 2014;113(4): 621-5.

39. Natsuaki M., Furukawa Y., Morimoto T. et al. Renal Function and Effect of Statin Therapy on Cardiovascular Outcomes in Patients Undergoing Coronary Revascularization. Am J Cardiol. 2012;110(11):1568-77.

40. Shepherd J., Kastelein J.P., Bittner V.A., et al. Intensive Lipid Lowering With Atorvastatin in Patients With Coronary Heart Disease and Chronic Kidney Disease: The TNT (Treating to New Targets) Study. J Am Coll Cardiol. 2008;51:1448-54.

41. KDIGO Clinical Practice Guideline for Lipid Management In Chronic Kidney Disease. Kidney Inter. 2013;3(suppl.)259-305.

42. Marcus F.I., Baumgarten A.J., Fritz W.L., et al. Alternate-day Dosing with Statins. The American Journal of Medicine. 2013;126(2):99-104.

43. Keating A.J., Campbell K.B., Guyton J.R., et al. Intermittent nondaily dosing strategies in patients with previous statin-induced myopathy. Ann Pharmacother. 2013;47(3):398-404.

44. Baigent C., Landray M.J., Reith C., et al. The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (Study of Heart and Renal Protection): a randomised placebo-controlled trial. Lancet. 2011;377:2181-92.

45. Palmer S.C., Di Micco L., Razavian M., et al. Effects of Antiplatelet Therapy on Mortality and Cardiovascular and Bleeding Outcomes in Persons With Chronic Kidney Disease. Ann Intern Med. 2012;156(6):445-59.

46. Segal R., Lubart E., Leibovitz A. et al. Early and late effects of low-dose aspirin on renal function in elderly patients. Am J Med. 2003;115:462-6.

47. Htun P., Fateh-Moghadam S., Bischofs C., et al. Low Responsiveness to Clopidogrel Increases Risk among CKD Patients Undergoing Coronary Intervention. J Am Soc Nephrol. 2011;22(4):627-33.

48. Mangiacapra F., Cavallari I., Barbato E., et al. Impact of Chronic Kidney Disease on Platelet Reactivity and Outcomes of Patients Receiving Clopidogrel and Undergoing Percutaneous Coronary Intervention. The American Journal of Cardiology. 2014;113(7):1124-9

49. Magnani G., Storey R.F., Steg G., et al. Efficacy and safety of ticagrelor for long-term secondary prevention of atherothrombotic events in relation to renal function: insights from the PEGASUS-TIMI 54 trial. Eur Heart J. 2016;37(4):400-8.

50. Pepine C.J., Rouleau J.L., Annis K., et al. Effects of angiotensin-converting enzyme inhibition on transient ischemia: The quinapril anti-ischemia and symptoms of angina reduction (QUASAR) trial. JACC. 2003;43:2049-59.

51. Hemmelgarn B.R., Southern D., Culleton B.F., et al. Survival After Coronary Revascularization Among Patients With Kidney Disease. Circulation. 2004; 110(14):1890-5.

52. Hillis G.S., Croal B.L., Buchan K.G., et al. Renal Function and Outcome From Coronary Artery Bypass Grafting: Impact on Mortality After a 2.3-Year Follow-Up. Circulation. 2006;113:1056-62.

53. Charytan D.M., Li S., Liu J., et al. Risks of Death and End-Stage Renal Disease After Surgical Compared With Percutaneous Coronary Revascularization in Elderly Patients With Chronic Kidney Disease. Circulation. 2012;126(11 suppl 1):S164-S169.

54. Guha A., Vei-Vei L., MacArthur A.E., et al. Short- and Long-Term Outcomes of Coronary Artery Bypass Grafting or Drug-Eluting Stent Implantation for Multivessel Coronary Artery Disease in Patients With CKD. The American Journal of Cardiology. 2010;106:348-53.

55. Cooper W.A., O'Brien S.M., Thourani V.H., et al. Impact of Renal Dysfunction on Outcomes of Coronary Artery Bypass Surgery: Results From the Society of Thoracic Surgeons National Adult Cardiac Database. Circulation. 2006;113:1063-70.

56. Holzmann M.J., Hammar N., Ahnve S., et al. Renal insufficiency and long-term mortality and incidence of myocardial infarction in patients undergoing coronary artery bypass grafting. Eur Heart J. 2007;28:865-71.

57. Chang T.I., Leong T.K., Boothroyd D.B., et al. Acute Kidney Injury After CABG Versus PCI: An Observational Study Using 2 Cohorts. J Am Coll Cardiol. 2014;64(10):985-94.

58. Mehta R.H., Honeycutt E., Patel U.D., et al. Impact of Recovery of Renal Function on Long-Term Mortality After Coronary Artery Bypass Grafting. The American journal of cardiology. 2010;106(12):1728-34.

59. Garg A.X., Devereaux P.J., Yusuf S., et al. Kidney Function After Off-Pump or On-Pump Coronary Artery Bypass Graft Surgery: A Randomized Clinical Trial. JAMA. 2014;311(21):2191-8.

60. Singh M., Singh P., Grewal P., et al. Clinical outcomes after percutaneous coronary intervention in patients with mild versus moderate renal insufficiency at 30-day and 1-year follow-up. Am J Ther. 2014;21(3):184-92.

61. Charytan D.M., Varma M.R., Silbaugh T.S., et al. Long-term Clinical Outcomes Following Drug-Eluting or Bare-Metal Stent Placement in Patients With Severely Reduced GFR. American Journal of Kidney Diseases. 2011;57(2):202-11.

62. Parikh P.B., Jeremias A., Naidu S.S., et al. Impact of severity of renal dysfunction on determinants of in-hospital mortality among patients undergoing percutaneous coronary intervention. Catheter Cardiovasc Interv. 2012;80(3):352-7.

63. Morel O., El Ghannudi S., Jesel L., et al. Cardiovascular Mortality in Chronic Kidney Disease Patients Undergoing Percutaneous Coronary Intervention Is Mainly Related to Impaired P2Y12 Inhibition by Clopidogrel. J Am Coll Cardiol. 2011;57(4):399-408.

64. Charytan D.M., Kuntz R.E., Chhabra A., Cutlip D.E. Relationship of chronic kidney disease to cardiovascular death and myocardial infarction following coronary stenting. J Nephrol. 2006;19(6): 764-70.

65. Green S.M., Selzer F., Mulukutla S.R. et al. Comparison of Bare-Metal and Drug-Eluting Stents in Patients with Chronic Kidney Disease (from the NHLBI Dynamic Registry). The American Journal of Cardiology. 2011;108(12):1658-64.

66. Wang Z.J., Harjai K.J., Shenoy C. et al. Drug-Eluting Stents Versus Bare-Metal Stents in Patients With Decreased GFR: A Meta-analysis. American Journal of Kidney Diseases. 2013;62(4):711-21.

67. Gradaus F., Ivens K., Peters A.J. et al. Angiographic progression of coronary artery disease in patients with end-stage renal disease. Nephrol Dial Transplant. 2001;16(6):1198-202.

68. Ohtake T., Kobayashi S., Moriya H., et al. High Prevalence of Occult Coronary Artery Stenosis in Patients with Chronic Kidney Disease at the Initiation of Renal Replacement Therapy: An Angiographic Examination. J Am Soc Nephrol. 2005;16:1141-8.

69. Herzog C.A., Littrell K., Arko C. et al. Clinical characteristics of dialysis patients with acute myocardial infarction in the United States: a collaborative project of the United States Renal Data System and the National Registry of Myocardial Infarction. Circulation. 2007;116:1465-72.

70. Sharma R., Pellerin D., Gaze D.C., et al. Dobutamine stress echocardiography and the resting but not exercise electrocardiograph predict severe coronary artery disease in renal transplant candidates. Nephrology Dialysis Transplantation. 2005;20(10):2207-14.

71. Mann D.M., Fernandez S., Mondal Z., et al. Role of Coronary Angiography in the Assessment of Cardiovascular Risk in Kidney Transplant Candidates. Am J Card. 2016;118(5):679-83.

72. Koulouridis I., Alfayez M., Trikalinos T.A., et al. Dose of Erythropoiesis-Stimulating Agents and Adverse Outcomes in CKD: A Meta-regression Analysis. American Journal of Kidney Diseases. 2013;61(1):44-56.

73. Wetmore J.B., Mahnken J.D., Phadnis M.A., et al. Relationship between calcium channel blocker class and mortality in dialysis. Pharmacoepidemiol Drug Saf. 2015;24(12):1249-58.

74. Kitchlu A., Clemens K., Gomes T., et al. Beta-blockers and cardiovascular outcomes in dialysis patients: a cohort study in Ontario, Canada. Nephrol Dial Transplant. 2012;27(4):1591-8.

75. Shireman T.I., Mahnken JD2, Phadnis MA2, Ellerbeck EF. Effectiveness comparison of cardio-selective to non-selective β-blockers and their association with mortality and morbidity in end-stage renal disease: a retrospective cohort study. BMC Cardiovasc Disord. 2016;16:60.

76. KDIGO Clinical Practice Guideline for Lipid Management In Chronic Kidney Disease. Kidney inter. 2013;3 (suppl.):259-305.

77. Ikari Y., Kyono H., Isshiki T., et al. Usefulness of Everolimus-Eluting Coronary Stent Implantation in Patients on Maintenance Hemodialysis. American Journal of Cardiology. 2015;116:872-876.

78. Yasuda K., Kasuga H., Aoyama T., et al. Comparison of Percutaneous Coronary Intervention with Medication in the Treatment of Coronary Artery Disease in Hemodialysis Patients. J Am Soc Nephrol. 2006;17: 2322-32.

79. Chang T.I., Montez-Rath M.E., Tsai T.T., et al. Drug-Eluting Versus Bare-Metal Stents During PCI in Patients With End-Stage Renal Disease on Dialysis. J Am Coll Cardiol. 2016;67(12):1459-69.

80. Hiremath S., Holden R.M., Fergusson D., et al. Antiplatelet Medications in Hemodialysis Patients: A Systematic Review of Bleeding Rates. Clin J Am Soc Nephrol. 2009;4(8):1347-55.

81. Charytan D.M., Kuntz R.E. Risks of coronary artery bypass surgery in dialysis-dependent patients— analysis of the 2001 National Inpatient Sample. Nephrol Dial Transplant. 2007;22:1665-71.

82. Charytan D.M., Desai M., Mathur M., et al. Reduced risk of myocardial infarct and revascularization following coronary artery bypass grafting compared with percutaneous coronary intervention in patients with chronic kidney disease. Kidney Int. 2016;90(2):411-21.

83. Krishnaswami A., Goh A.C.H., Go A.S., et al. Effectiveness of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With End-Stage Renal Disease. Am J Card. 2016;117(10):1596-603.

84. Bangalore S., Guo Y., Samadashvili Z., et al. Revascularization in Patients With Multivessel Coronary Artery Disease and Chronic Kidney Disease: Everolimus-Eluting Stents Versus Coronary Artery Bypass Graft Surgery. J Am Coll Cardiol. 2015;66(11):1209-20.

85. Marui A., Kimura T., Nishiwaki N., et al. Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With End-Stage Renal Disease Requiring Dialysis. The American Journal of Cardiology. 2014;114:555-561.

86. Shroff G.R., Solid C.A., Herzog C.A. Long-Term Survival and Repeat Coronary Revascularization in Dialysis Patients After Surgical and Percutaneous Coronary Revascularization With Drug-Eluting and Bare Metal Stents in the United States. Circulation. 2013;127(18):1861-9.

87. Guha A., Vei-Vei L., MacArthur A.E., et al. Short- and Long-Term Outcomes of Coronary Artery Bypass Grafting or Drug-Eluting Stent Implantation for Multivessel Coronary Artery Disease in Patients With CKD. The American Journal of Cardiology. 2010;106:348-53.


For citations:

Belyalov F.I. ISCHEMIC HEART DISEASE AND RENAL DYSFUNCTION. Rational Pharmacotherapy in Cardiology. 2017;13(3):409-415. (In Russ.)

Views: 904

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)