Edwards N C, Steeds R P, Ferro C J, Townend J N
Research Fellow in Cardiology, Department of Cardiovascular Medicine, University of Birmingham, Birmingham, UK.
QJM. 2006 Nov;99(11):723-36. doi: 10.1093/qjmed/hcl101. Epub 2006 Oct 13.
Premature cardiovascular disease is the largest cause of mortality, and a major cause of morbidity, in patients with chronic kidney disease (CKD). Patients with end-stage kidney disease (ESKD) are at extreme risk, but cardiovascular event rates are increased even in early CKD. There is little controlled trial evidence on which to base treatment, as most therapeutic trials have excluded CKD patients. Current treatment strategies are therefore based upon small prospective studies or retrospective analyses of controlled trials and registry data. It is thus unclear whether CKD patients benefit from modern secondary preventive treatments in the same manner as patients with normal renal function. There is a need for randomized trials to identify effective drugs to prevent and treat coronary artery disease in CKD. Revascularization by CABG in CKD has been widely reported in registry data to provide better results than medical treatment or angioplasty. Recent angioplasty data in patients with CKD, however, show improving results, and the risks of CABG in CKD remain high. It is not clear which revascularization technique has a better outcome in patients 'equally suitable' on angiographic criteria for either procedure. The high rate of late adverse cardiovascular events after both CABG and angioplasty accentuates the need for effective secondary preventive therapy disease in these high-risk patients.
在慢性肾脏病（CKD）患者中，心血管疾病过早发生是导致死亡的最大原因，也是发病的主要原因。终末期肾病（ESKD）患者面临极高风险，但即使在CKD早期，心血管事件发生率也会升高。由于大多数治疗试验都将CKD患者排除在外，因此几乎没有可作为治疗依据的对照试验证据。所以，目前的治疗策略是基于小型前瞻性研究或对对照试验及登记数据的回顾性分析。因此，尚不清楚CKD患者是否能像肾功能正常的患者一样从现代二级预防治疗中获益。需要进行随机试验来确定预防和治疗CKD患者冠状动脉疾病的有效药物。CKD患者接受冠状动脉旁路移植术（CABG）进行血运重建的情况在登记数据中有广泛报道，结果显示比药物治疗或血管成形术更好。然而，近期CKD患者血管成形术的数据显示结果在改善，且CKD患者接受CABG的风险仍然很高。对于在血管造影标准上“同样适合”这两种手术的患者，尚不清楚哪种血运重建技术能带来更好的结果。CABG和血管成形术后晚期不良心血管事件的高发生率凸显了在这些高危患者中进行有效二级预防治疗的必要性。
