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Pharmacological and non pharmacological strategies in the management of coronary artery disease and chronic kidney disease.
Curr Cardiol Rev. 2015; 11(3):261-9.CC

Abstract

Patients with advanced chronic kidney disease (CKD), including those treated with dialysis, are at high risk for the development of cardiovascular disease (CVD). CVD accounts for 45-50% of deaths among dialysis patients. Therapy of acute and chronic coronary heart disease (CHD) that is effective in the general population is frequently less effective in patients with advanced CKD. Drug therapy in such patients may require dose modification in some cases. Oral anti-platelet drugs are less effective in those with advanced CKD than in persons with normal or near normal renal function. The intravenous antiplatelet drugs eptifibatide and tirofiban both require dose reductions in patients with advanced CKD. Enoxaparin requires dose reduction in early stage CKD and is contraindicated in hemodialysis patients. Unfractionated heparin and warfarin maybe used without dose adjustment in CKD patients. Atenolol, acetbutolol and nadolol may require dose adjustments in CKD. Metoprolol and carvedilol do not. Calcium channel blockers and nitrates do not require dose adjustment, whereas ranolazine does. Angiotensin converting enzyme inhibitors and angiotensin receptor blockers may safely be used in CKD patients with close observation for hyperkalemia. The safety of spironolactone in such patients is questionable. Statins are less effective in reducing cardiovascular complication in CKD patients and their initiation is not recommended in dialysis patients. Coronary artery bypass grafting is associated with higher shortterm mortality, but better long-term morbidity and mortality than percutaneous coronary interventions in patients with advanced CKD with non-ST segment ACS and chronic CHD.

Authors+Show Affiliations

No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableRm CE-306, University of Missouri Health Sciences Center, 5 Hospital Drive, Columbia, MO, USA 65212. turagamm@health.missouri.edu.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

25981315

Citation

Agrawal, Harsh, et al. "Pharmacological and Non Pharmacological Strategies in the Management of Coronary Artery Disease and Chronic Kidney Disease." Current Cardiology Reviews, vol. 11, no. 3, 2015, pp. 261-9.
Agrawal H, Aggarwal K, Littrell R, et al. Pharmacological and non pharmacological strategies in the management of coronary artery disease and chronic kidney disease. Curr Cardiol Rev. 2015;11(3):261-9.
Agrawal, H., Aggarwal, K., Littrell, R., Velagapudi, P., Turagam, M. K., Mittal, M., & Alpert, M. A. (2015). Pharmacological and non pharmacological strategies in the management of coronary artery disease and chronic kidney disease. Current Cardiology Reviews, 11(3), 261-9.
Agrawal H, et al. Pharmacological and Non Pharmacological Strategies in the Management of Coronary Artery Disease and Chronic Kidney Disease. Curr Cardiol Rev. 2015;11(3):261-9. PubMed PMID: 25981315.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pharmacological and non pharmacological strategies in the management of coronary artery disease and chronic kidney disease. AU - Agrawal,Harsh, AU - Aggarwal,Kul, AU - Littrell,Rachel, AU - Velagapudi,Poonam, AU - Turagam,Mohit K, AU - Mittal,Mayank, AU - Alpert,Martin A, PY - 2014/06/13/received PY - 2014/12/18/revised PY - 2015/01/08/accepted PY - 2015/5/19/entrez PY - 2015/5/20/pubmed PY - 2015/9/1/medline SP - 261 EP - 9 JF - Current cardiology reviews JO - Curr Cardiol Rev VL - 11 IS - 3 N2 - Patients with advanced chronic kidney disease (CKD), including those treated with dialysis, are at high risk for the development of cardiovascular disease (CVD). CVD accounts for 45-50% of deaths among dialysis patients. Therapy of acute and chronic coronary heart disease (CHD) that is effective in the general population is frequently less effective in patients with advanced CKD. Drug therapy in such patients may require dose modification in some cases. Oral anti-platelet drugs are less effective in those with advanced CKD than in persons with normal or near normal renal function. The intravenous antiplatelet drugs eptifibatide and tirofiban both require dose reductions in patients with advanced CKD. Enoxaparin requires dose reduction in early stage CKD and is contraindicated in hemodialysis patients. Unfractionated heparin and warfarin maybe used without dose adjustment in CKD patients. Atenolol, acetbutolol and nadolol may require dose adjustments in CKD. Metoprolol and carvedilol do not. Calcium channel blockers and nitrates do not require dose adjustment, whereas ranolazine does. Angiotensin converting enzyme inhibitors and angiotensin receptor blockers may safely be used in CKD patients with close observation for hyperkalemia. The safety of spironolactone in such patients is questionable. Statins are less effective in reducing cardiovascular complication in CKD patients and their initiation is not recommended in dialysis patients. Coronary artery bypass grafting is associated with higher shortterm mortality, but better long-term morbidity and mortality than percutaneous coronary interventions in patients with advanced CKD with non-ST segment ACS and chronic CHD. SN - 1875-6557 UR - https://www.unboundmedicine.com/medline/citation/25981315/Pharmacological_and_non_pharmacological_strategies_in_the_management_of_coronary_artery_disease_and_chronic_kidney_disease_ L2 - http://www.eurekaselect.com/131302/article DB - PRIME DP - Unbound Medicine ER -