Coronary artery disease in dialysis patients: What is the optimal therapy?

Chu-Lin Chou^{a, b}, Te-Chao Fang^{a, b, c}

^a Division of Nephrology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
^b Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
^c School of Medicine, Tzu Chi University, Hualien, Taiwan

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Abstract
Coronary artery disease (CAD) carries a high risk of mortality in dialysis patients. End-stage renal disease is considered to increase the vulnerability of patients with atherosclerosis superimposed on artery calcification. Recently, an increasing prevalence of CAD in dialysis patients has been attributed to a lack of effective prevention and treatment. Further studies have shown that optimal therapies for CAD in dialysis patients remain neglected and unclarified. These therapies include correction of anemia, control of blood pressure, and antiplatelet therapy. Because of bleeding tendencies in dialysis patients, the benefits of antiplatelet therapy and platelet glycoprotein IIb/IIIa inhibitors for treating CAD require more research. In addition, a meta-analysis of retrospective studies in 2012 showed that dialysis patients with CAD receiving coronary artery bypass surgery had a lower long-term mortality rate and fewer postoperative cardiac complications than those receiving percutaneous coronary angioplasty. A large randomized, long-term cohort study is necessary to confirm these issues.

Keywords
Coronary artery bypass grafting; Coronary artery disease; Dialysis; Percutaneous transluminal coronary angioplasty; Stent