Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK and.
School of Health and Related Research, University of Sheffield, Sheffield, UK.
Platelets. 2023 Dec;34(1):2154330. doi: 10.1080/09537104.2022.2154330.
Chronic kidney disease (CKD) is a global health problem and an independent risk factor for cardiovascular morbidity and mortality. Despite evidence-based therapies significantly improving cardiovascular mortality outcomes in the general population and those with non-dialysis-dependent CKD, this risk reduction has not translated to patients with end-stage kidney disease (ESKD). Absent from all major antiplatelet trials, this has led to insufficient safety data for P2Y inhibitor prescriptions and treatment inequity in this subpopulation. This review article presents an overview of the progression of research in understanding antiplatelet therapy for ischaemic heart disease in patients with advanced CKD (defined as eGFR <30 mL/min/1.73 m). Beyond trial recruitment strategies, new approaches should focus on registry documentation by CKD stage, risk stratification with biomarkers associated with inflammation and haemorrhage and building a knowledge base on optimal duration of dual and single antiplatelet therapies.
慢性肾脏病（CKD）是一个全球性的健康问题，也是心血管发病率和死亡率的独立危险因素。尽管基于证据的治疗方法显著改善了普通人群和非透析依赖型 CKD 患者的心血管死亡率，但这一风险降低并未转化为终末期肾病（ESKD）患者。所有主要抗血小板试验都没有涉及到这一点，因此，在这一亚人群中，P2Y 抑制剂处方的安全性数据不足，治疗也不公平。本文综述了对晚期 CKD（定义为 eGFR <30 mL/min/1.73 m）患者缺血性心脏病抗血小板治疗研究进展的概述。除了试验招募策略外，新的方法还应侧重于按 CKD 阶段进行登记处的记录、使用与炎症和出血相关的生物标志物进行风险分层，以及建立关于双联和单联抗血小板治疗最佳持续时间的知识库。
