Coronary Artery Disease and Impaired Renal Function

Patients with chronic kidney disease (CKD) present with an accelerated form of coronary artery disease. Their vascular morbidity and mortality are significantly increased compared to the general population. In addition to traditional risk factors, there are also factors related to uremia and dialysis, which together induce an acute phase reaction via cytokine release and endothelial dysfunction. This chronic microinflammatory environment, combined with a defective immune system and disturbances in calcium and phosphate metabolism, leads to severe atherosclerosis. Coronary artery disease in chronic kidney disease. Patients with chronic kidney disease (CKD) present with a very early and severe form of coronary artery disease. Morbidity and mortality are extremely high. This is because, in addition to classic risk factors, uremia and dialysis induce cytokine release and changes in lipid metabolism, which creates a microinflammatory environment. This leads to an acute phase reaction and endothelial dysfunction. This reaction is accelerated by a defective immune system and disturbances in calcium and phosphate metabolism. The conservative treatment approach is similar to that for patients without kidney failure, but coronary artery bypass grafting is superior to PTCA ± stent implantation based on long-term follow-up. The use of arterial grafts significantly reduces morbidity and mortality, particularly in diabetics.