Management of Coronary Disease in Patients with Advanced Kidney Disease

This randomized trial (ISCHEMIA-CKD) assessed outcomes in 777 patients with stable coronary artery disease, advanced chronic kidney disease, and moderate or severe ischemia. Patients were assigned to either an invasive strategy (coronary angiography and possible revascularization plus medical therapy) or a conservative strategy (medical therapy alone with angiography only if medical therapy failed). Over a median follow-up of 2.2 years, there was no significant difference in the primary outcome death or nonfatal myocardial infarction or in key secondary events. However, the invasive strategy led to higher risks of stroke and dialysis initiation. The findings suggest no additional benefit from an invasive approach in this high-risk population.

This randomized trial (ISCHEMIA-CKD) assessed outcomes in 777 patients with stable coronary artery disease, advanced chronic kidney disease, and moderate or severe ischemia. Patients were assigned to either an invasive strategy (coronary angiography and possible revascularization plus medical therapy) or a conservative strategy (medical therapy alone with angiography only if medical therapy failed). Over a median follow-up of 2.2 years, there was no significant difference in the primary outcome death or nonfatal myocardial infarction or in key secondary events. However, the invasive strategy led to higher risks of stroke and dialysis initiation. The findings suggest no additional benefit from an invasive approach in this high-risk population.