Percutaneous coronary intervention versus coronary artery bypass graft in chronic kidney disease: Optimal treatment options.

Chronic kidney disease (CKD) is ubiquitous in the world and may eventually progress to end-stage renal disease. CKD is associated with a greater risk of coronary artery disease (CAD) which is the leading cause of mortality in this population. Current invasive treatment options include percutaneous coronary intervention or coronary artery bypass graft.

Advances in percutaneous coronary intervention in patients with chronic kidney disease.

Coronary artery disease is the number one cause of death in patients with chronic kidney disease (CKD). However,patients with impaired renal function are much less likely than patients with normal renal function to undergo left heart catheterization and coronary intervention. Patients that do receive invasive strategies experience more bleeding and higher rates of ischemic events.

The development and application of the implantable cardioverter defibrillator.

Several years ago, implantable defibrillators were recommended only for survivors of cardiac arrest. With improvement of surgical techniques and advancement in technology, defibrillator implantation is now considered an outpatient procedure. Clinical trials have now demonstrated improvement in survival in high risk patients who receive defibrillators which has greatly increased the number of defibrillators implanted.

Assessing cardiovascular disease in the dialysis patient.

Cardiac causes account for nearly half of all deaths in patients with end-stage renal disease (ESRD). Coronary artery disease (CAD) is present in 38% - 40% of patients starting dialysis. Both traditional and chronic kidney disease-related cardiovascular risk factors contribute to this high prevalence rate.

Utility of echocardiography in the evaluation of coronary artery disease in patients with end-stage renal disease.

Patients with chronic kidney disease (CKD) are at increased risk of cardiovascular events. Echocardiography is an integral part of the evaluation of coronary artery disease. Chronic kidney disease has a predictable and unique effect on the myocardium and the epicardial circulation that may be detected by echocardiography.

Management of coronary artery disease in patients with chronic kidney disease.

Patients with chronic kidney disease (CKD) are considered to belong to the highest risk group for the development of cardiovascular events. These patients should be subject to aggressive risk-factor modification. However, management of coronary artery disease in patients with CKD can be uniquely challenging.

Changing conduction abnormalities in a dialysis patient with fever.

A patient on hemodialysis with severe aortic valve disease and presumed arteriovenous fistula infection was found to have new-onset atrial fibrillation and alternating left and right bundle branch block patterns on serial electrocardiograms. These findings prompted transesophageal echocardiography, which revealed a large abscess involving the intervalvular fibrosa and the posterior cusp of the bicuspid aortic valve. Hence, basic bedside diagnostic skills remain important in the era of sophisticated imaging techniques and laboratory analyses.