Abstract
Patients with advanced chronic kidney disease (CKD), including those treated with dialysis, are at high risk for the development of cardiovascular disease (CVD). CVD accounts for 45-50% of deaths among dialysis patients. Therapy of acute and chronic coronary heart disease (CHD) that is effective in the general population is frequently less effective in patients with advanced CKD. Drug therapy in such patients may require dose modification in some cases. Oral anti-platelet drugs are less effective in those with advanced CKD than in persons with normal or near normal renal function. The intravenous antiplatelet drugs eptifibatide and tirofiban both require dose reductions in patients with advanced CKD. Enoxaparin requires dose reduction in early stage CKD and is contraindicated in hemodialysis patients. Unfractionated heparin and warfarin maybe used without dose adjustment in CKD patients. Atenolol, acetbutolol and nadolol may require dose adjustments in CKD. Metoprolol and carvedilol do not. Calcium channel blockers and nitrates do not require dose adjustment, whereas ranolazine does. Angiotensin converting enzyme inhibitors and angiotensin receptor blockers may safely be used in CKD patients with close observation for hyperkalemia. The safety of spironolactone in such patients is questionable. Statins are less effective in reducing cardiovascular complication in CKD patients and their initiation is not recommended in dialysis patients. Coronary artery bypass grafting is associated with higher shortterm mortality, but better long-term morbidity and mortality than percutaneous coronary interventions in patients with advanced CKD with non-ST segment ACS and chronic CHD.
Keywords: Chronic kidney disease, end-stage renal disease, dialysis and hemodialysis, acute coronary syndrome, chronic coronary heart disease, pharmacotherapy, myocardial revascularization.
Graphical Abstract
[1]
U.S. Renal Data System USRDS 2013 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States National Institute of Health, National Institute of
Diabetes and Digestive and Kidney Diseases, Bethesda, MD. 2013.
[2]
Levey AS, de Jong PE, Coresh J, et al. Definition and classification of chronic kidney disease; a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 2005; 67(6): 2089-100.
[3]
Weiner D, Tabatabais E, Tighiouart H, et al. Cardiovascular outcomes and all-cause mortality: exploring the interaction between CKD and cardiovascular disease. Am J Kidney Dis 2006; 48(3): 392-401.
[4]
Sarnak MS, Coronado BE, Greene T, et al. Cardiovascular disease risk factors in chronic renal insufficiency. Clin Nephrol 2002; 57(5): 327-35.
[5]
Goldsmith DJ, Covic A. Coronary artery disease in uremia: Etiology, diagnosis, and therapy. Kidney Int 2001; 60(6): 2059-78.
[6]
Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004; 351(10): 1296-305.
[7]
Coresh J, Longnecker JC, Miller ER 3rd, Young HJ, Klag MJ. Epidemiology of cardiovascular risk factors in chronic renal disease. J Am Soc Nephrol 1998; 9(12)(Suppl.): S24-30.
[8]
Schiffrin EL, Lipman ML, Mann JF. Chronic kidney disease: effects on the cardiovascular system. Circulation 2007; 116(1): 85-97.
[9]
Cheung AK, Sannak MJ, Yan G, et al. Cardiac disease in maintenance hemodialysis patients. Kidney Int 2004; 65: 2380-9.
[10]
U.S. Renal Data System, USRDS 2002-2013 Annual Data Reports:
Atlas of Chronic Kidney Disease and End-Stage Renal Disease in
the United States, National Institutes of Health, National Institute
of Diabetes and Digestive and Kidney Disease, Bethesda, 2002- 2013.
[11]
Parekh RS, Zhang L, Fivush BA, Klag MJ. Incidence of an atherosclerosis by race in the Dialysis and Mortality Study – a sample of the CUS ESRD population. J Am Soc Nephrol 2005; 16: 1420-6.
[12]
Ohtake T, Kobayasni S, Moriya H, et al. High prevalence of occult coronary artery stenosis in patients with chronic kidney disease at the initiation of renal replacement therapy: an angiographic examination. J Am Soc Nephrol 2005; 16: 1441-8.
[13]
Charytan D, Kuntz RE, Mauri L, DeFillippi C. Distribution of coronary artery disease and relation to mortality in asymptomatic hemodialysis patients. Am J Kidney Dis 2007; 49: 409-16.
[14]
Conlon PJ, Krucofff MW, Minda S, Schumm D, Schwab SJ. Incidence and long-term significance of transient ST segment deviation in hemodialysis patients. Clin Nephrol 1998; 244: 155-61.
[15]
Parfrey PS, Foley RN. The clinical epidemiology of cardiac disease in chronic renal failure. J Am Soc Nephrol 1999; 10: 1606-15.
[16]
U.S. Renal Data System.The USRDS Dialysis Morbility and Mortality Study, Wave 2. Am J Kidney Dis 1997; 30(2)(Suppl. 1): S67-85.
[17]
Balla S, Nusair MB, Alpert MA. Risk factors for cardiovascular disease in patients with chronic kidney disease. Curr Opin Pharmacol 2013; 13: 192-9.
[18]
Shlipak MG, Fried LF, Cushman M, et al. Cardiovascular mortaility risk in chronic kidney disease; comparison of traditional and novel risk factors. JAMA 2005; 293: 1737-45.
[19]
Tonelli M, Wiebe N, Culleton B, et al. Chronic kidney disease and mortality risk: a systematic review. J Am Soc Nephrol 2006; 17(7): 2034-47.
[20]
Jaki N, Hase H, Nakamura R, Yamaguchi T. Onset of coronary artery disease prior to initiation of haemodialysis in patients with end-stage renal disease. Nephrol Dial Transplant 1997; 12: 718-23.
[21]
Anderson JL, Adams CD, Antman EM, et al. 2012 ACCF/AHA focused update incorporated into the ACCF/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013; 61(23): e179-347.
[22]
American College of Cardiology Foundation/American Heart Association
Task Force on Practice Guidelines: developed in collaboration with the American College of Emergency Physicians and Society for Cardiovascular Angiography and Interventions. Catheter Cardiovasc Interv 2013; 82(1): E1-E27.
[23]
Sarnak MS, Levey AS, Schoolwerth AC, et al. Kidney disease as a risk factor for development of cardiovascular disease. Circulation 2003; 108: 2154-69.
[24]
K/DOQI Workgroup,K.D., K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. Am J Kidney Dis 2005; 45(4)(Suppl. 3): S1-S153.
[25]
Coats WC, Baig SZ, Alpert MA, Aggarwal K. Management of coronary artery disease in patients with chronic kidney disease. Adv Perit Dial 2009; 25: 125-8.
[26]
Herzog CA. How to manage the renal patient with coronary heart disease: the agony and the ecstasy of opinion-based medicine. J Am Soc Nephrol 2003; 14(10): 2556-72.
[27]
Herzog CAMAJL, Collins AJ. Poor long-term survival after acute myocardial infarction among patients on long-term dialysis. N Engl J Med 1998; 339(12): 799-805.
[28]
Glorieux G, Cohen G, Jankowski J, Vanderholder R. Platelet/Leukocyte activation, inflammation, and uremia. Semin Dial 2009; 22(4): 423-7.
[29]
Gum PA, Thamilarasan M, Watanabe J, Blackstone EH, Lauer MS. Aspirin use and all-cause mortality among patients being evaluated for known or suspected coronary artery disease: A propensity analysis. JAMA 2001; 286(10): 1187-94.
[30]
Jardine MJ, Ninoniva T, Perkovic V, et al. Aspirin is beneficial in hypertensive patients with chronic kidney disease: a post-hoc subgroup analysis of a randomized controlled trial. J Am Coll Cardiol 2010; 56(12): 956-65.
[31]
Palmer SC, DiMicco L, Razavian M, et al. Antiplatelet agents for chronic kidney disease. Cochrane Database Syst Rev 2013; 2CD008834
[32]
Cuisset T, Fieri C, Moro PJ, et al. Lack of effect of chronic kidney disease on clopidogrel response with high loading and maintenance doses of clopidogrel after acute coronary syndrome. Thromb Res 2010; 126(5): e400-2.
[33]
Morel O, El Ghannudi S, Jesel L, et al. Cardiovascular mortality in chronic kidney disease patients undergoing percutaneous coronary intervention is mainly related to impared P2Y inhibition by clopidogrel. J Am Cardiol 2011; 57(4): 399-408.
[34]
Best PJ, Steinhubl SR, Berger PB, et al. The efficacy and safety of short- and long-term dual antiplatelet therapy in patients with mild or moderate chronic kidney diese: results from the Clopidogrel for the Reduction of Events During Observation (CREDO) trial. Am Heart J 2008; 155(4): 687-93.
[35]
Small DS, Wurishko RE, Ernest CS II, et al. Prasugrel pharmacokinetics and pharmacodynamics in subjects with moderate renal impairment and end-stage renal disease. J Clin Pharm Ther 2009; 34(5): 585-94.
[36]
James S, Budai A, Aylward A, et al. Ticagrelor versus clopidogrel in acute coronary syndromes in relation to renal function: results from the Platelet Inhibition and Patient Outcomes (PLATO) trial. Circulation 2010; 122(11): 1056-67.
[37]
Wallentin L, Becker RC, Budai A, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2009; 361(11): 1045-57.
[38]
Heeschen C, Hamm CW, Mitrovic V, Lantelme NH, White HD. Troponin concentrations for stratification of patients with acute coronary sundromes in relation to therapeutic efficacy of tirofiban. PRISM Study Investigators. Platelet Receptor Inhibition in Ischemic Syndrome Management. Lancet 1999; 354: 1757-62.
[39]
Hamm CW, Heeschen C, Goldmann B, et al. Benefit of abciximab in patients with refractory unstable angina in relation to serum troponin T levels. C7E3 Fab Anitplatelet Therapy in Unstable Refractory Angina (CAPTURE) Study Investigators. N Engl J Med 1999; 340(21): 1623-9.
[40]
Freeman RV, Mehta RH, Al Badr W, Cooper JV, Kline-Rogers E, Eagle KA. Influence of concurrent renal dysfunction on outcomes of patients with acute coronary syndromes and implications of the use of glycoprotein IIB/IIIa inhibitors. J Am Coll Cardiol 2003; 41(5): 718-24.
[41]
Tsai TT, Maddox TM, Roe MT, et al. Contraindicated medication use in dialysis patients undergoing percutaneous coronary intervention. JAMA 2009; 302(22): 2458-64.
[42]
Harrington RA, Becker RC. Ezekowicz, et al. Antithrombotic
therapy for non-ST-segment elevation acute coronary syndromes:
American College of Chest Physicians Evidence-Based Clinical
Practice Guidelines (8th Edition). Chest 2008. 133(6 Suppl): 670S-
707S.
[43]
Gerlach AT, Pickworth KK, Seth SK, Tanna SB, Barnes JF. Enoxaparin and bleeding complications: a review in patients with and without renal insufficiency. Pharmacotherapy 2000; 20(7): 771-5.
[44]
Thorevska N, Amoateng-Adjepong Y, Sabahi R, et al. Anitcoagulation in hospitalizied patients with renal insufficiency: a comparison of bleeding rates with unfractionated heparin vs enoxaparin. Chest 2004; 125(3): 856-63.
[45]
Achardji S, Baber U, Mehran R, et al. Prognostic significance of elevated baseline troponin in patients with acute coronary syndromes and chronic kidney disease treated with different antithrombotic regimens: a substudy from the ACUITY trial. Circ Cardiovasc Interv 2012; 5(2): 157-65.
[46]
Stangier J, Rathgen K, Stahle H, Mazur D. Influence of renal impairment on the pharmacokinetics and pharmacodynamics of oral dabigatran etexilate: an open-label, parallel-group, single-centre study. Clin Pharmacokinet 2010; 49(4): 259-68.
[47]
Mega JL, Braunwald E, Mohanavelu S, et al. Rivaroxaban versus placebo in patients with acute coronary syndromes (ATLAS ACS-TIMI 46): a randomized, double-blind, phase II trial. Lancet 2009; 374: 29-38.
[48]
APPRAISE Steering Committee and Investigators. Apixaban, an oral, direct, selective factor Xa inhibitor, in combination with antiplatelet therapy after acute coronary syndrome: results of the Apixaban for Prevention on Acute Ischemic and Safety Events (APPRAISE) trial. Circulation 2009; 119(22): 2877-85.
[49]
Badve SV, Roberts MA, Hawley CM, et al. Effects of beta-adrenergic antagonists in patients with chronic kidney disease: a systematic review and meta-analysis. J Am Coll Cardiol 2011; 58(11): 1152-61.
[50]
Berger AK, Duvat S, Krumholz HM. Aspirin, beta-blocker, and angiotensin-converting enzyme inhibitor therapy in patients with end-stage renal disease and an acute myocardial infarction. J Am Coll Cardiol 2003; 42(2): 201-8.
[51]
Inrig JK. Antihypertensive agents in hemodialysis patients: a current perspective. Semin Dial 2010; 23(3): 290-7.
[52]
Agarwal R. Supervised atenolol therapy in the management of hemodialysis hypertension. Kidney Int 1999; 55(4): 1528-35.
[53]
Tepel M, Hopfenmueller W, Scholze A, Maier A, Zidek W. Effect of amlodipine on cardiovascular events in hypertensive haemodialysis patients. Nephrol Dial Transplant 2008; 23(11): 3605-12.
[55]
Morrow DA, Scirica BM, Karwatowska-Prokopczuk E, et al. Effects of ranolazine on recurrent cardiovascular events in patients with non-ST-elevation acute coronary syndromes: the MERLIN-TIMI 36 randomized trial. JAMA 2007; 297(16): 1775-83.
[56]
Han SW, Won YW, Yi JH, Kim HJ. No impact of hyperkalaemia with renin-angiotensin system blockade in maintenance haemodialysis patients. Nephrol Dial Transplant 2007; 22(4): 1150-5.
[57]
Zannad F, Kessler M, Lehert P, et al. Prevention of cardiovascular events in end-stage renal disease: results of a randomized trial of fosinopril and implications for future studies. Kidney Int 2006; 70(7): 1318-24.
[58]
Garthwaite E, Bhandari S. The effects of angiotensin converting enzyme inhibitors on potassium homeostasis in dialysis patients with and without residual renal function. Artif Organs 2009; 33(8): 641-7.
[59]
Knoll GA, Saghal A, Nair RC, Graham J, Van Wakaren C, Burns KD. Renin-angiotensin system blockade and the risk of hyperkalemia in chronic hemodialysis patients. Am J Med 2002; 12(2): 110-4.
[60]
Efrati S, Zaldenstein R, Dishy V, et al. ACE inhibitors and survival of hemodialysis patients. Am J Kidney Dis 2002; 40(5): 1023-9.
[61]
McCullough PA, Sandberg KR, Yee J, Hudson MP. Mortality benefit of angiotensin-converting enzyme inhibitors after cardiac events in patients with end-stage renal disease. J Renin Angiotensin Aldosterone Syst 2002; 3(3): 188-91.
[62]
Suzuki H, Kanno Y, Sugahara S, et al. Effect of angiotensin receptor blockers on cardiovascular events in patients undergoing hemodialysis: an open-label randomized controlled trial. Am J Kidney Dis 2008; 52(3): 501-6.
[63]
Takahashi A, Takese H, Tariyama T, et al. Candesartan, an angiotensin II type-1 receptor blocker, reduces cardiovascular events in patients on chronic haemodialysis-a randomized study. Nephrol Dial Transplant 2006; 21(9): 2507-12.
[64]
Fried LF, Emanuele N, Zhang JH. Combined angiotensin inhibition for the treatment of diabetic nephropathy. N Engl J Med 2013; 369(20): 1892-903.
[65]
ONTARGET Investigators Telmisartan, ramipril or both in patients at high risk for vascular events. N Engl J Med 2008; 358(15): 1547-59.
[66]
Hussain S, Dreyfus DE, Marcus RJ, Biederman RW, McDill RL. Is spironolactone safe for dialysis patients? Nephrol Dial Transplant 2003; 18(11): 2364-8.
[67]
Matsumoto Y, Kageyama S, Yakushigawa T, et al. Long-term low-dose spironolactone therapy is safe in oligoanuric hemodialysis patients. Cardiology 2009; 114(1): 32-8.
[68]
Saudan P, Mach F, Perneger T, et al. Safety of low-dose spironolactone administration in chronic haemodialysis patients. Nephrol Dial Transplant 2003; 18(11): 2359-63.
[69]
Matsumoto Y, Mori Y, Kageyama S, et al. Spironolactone reduces cardiovascular and cerebrovascular morbidity and mortality in hemodialysis patients. J Am Coll Cardiol 2014; 63(6): 528-36.
[70]
Goicoechea M, DeVinuesa SG, Lahera V, et al. Effects of atorvastatin on inflammatory and fibrinolytic parameters in patients with chronic kidney disease. J Am Soc Nephrol 2006; 17(12)(Suppl. 3): S231-5.
[71]
Shepherd J, Kastelein JJ, Bittner V, et al. Intensive lipid lowering with atorvastatin in patients with coronary heart disease and chronic kidney disease: the TNT (Treating to New Targets) study. J Am Coll Cardiol 2008; 51(15): 1448-54.
[72]
German Diabetes and Dialysis Study Investigators. Atorvastatin in patients with type 2 diabetes mellitus undergoing hemodialysis. N Engl J Med 2005; 353(3): 238-48.
[73]
AURORA Study Group. Rosuvastatin and cardiovascular events in patients undergoing hemodialysis. N Engl J Med 2009; 360(14): 1395-407.
[74]
SHARP Investigators.The effects of lowering LDL cholesterol with simvastatin plus ezetimible in patients with chronic kidney disease (Study of Heart and Renal Protection): a randomized placebo-controlled trial. Lancet 2011; 377(9784): 2181-92.
[75]
Holdaas H, Holme I, Schmeider RE, et al. Rosuvastatin in diabetic hemodialysis patients. J Am Soc Nephrol 2011; 22(7): 1335-41.
[76]
Krane V, Wanner C. Statins, inflammation and kidney disease. Nat Rev Nephrol 2011; 7(7): 385-97.
[77]
Vaziri ND, Norris KC. Reasons for the lack of salutary effects of cholesterol-lowering interventions in end-stage renal disease populations. Blood Purif 2013; 35(1-3): 31-6.
[78]
Tonelli M, Warner C. for the Kidney Disease:Improving Global Outcomes Lipid Guideline Development Work Group. Lipid management in chronic kidney disease: Synopsis of the kidney disease: Improving Global Outcomes 2013 clinical practice guideline. Ann Intern Med 2014; 160(3): 182.
[79]
Anavekar NS, McMurray JJ, Velaquez EJ, et al. Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction. N Engl J Med 2004; 351(13): 1285-95.
[80]
Charytan DM, Kuntz RE, Garshick M, Candia S, Kahn MF, Mauri L. Location of acute coronary artery thromboses in patients with and without chronic kidney disease. Kidney Int 2009; 75(1): 80-7.
[81]
Szummer K, Lundman P, Jacobson SH, et al. Influence of renal function on the effects of early revascularization in non-ST-elevation myocardial infarction: data from the Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluate According to Recommended Therapies (SWEDEHEART). Circulation 2009; 120(10): 851-8.
[82]
Huang HD, Alam M, Hamzeh I, et al. Patients with severe chronic kidney disease benefit from early revascularization after acute coronary syndrome. Int J Cardiol 2013; 168(4): 3741-6.
[83]
APPROACH Investigators. Survival after coronary revascularization among patients with kidney disease. Circulation 2004; 110(14): 1890-5.
[84]
Szczech LA, Reddan DN, Owen WF, et al. Differential survival after coronary revascularization procedures among patients with renal insufficiency. Kidney Int 2001; 60(1): 292-9.
[85]
Manabe S, Shimokawa T, Fukui T, et al. Coronary artery bypass surgery versus percutaneous coronary artery intervention in patients on chronic hemodialysis: does a drug-eluting stent have an impact on clinical outcome? J Card Surg 2009; 24(3): 234-9.
[86]
Sunagawa G, Komiya T, Tamura N, Sakaguchi G, Kobayashi T, Murushila T. Coronary artery bypass surgery is superior or percutaneous coronary intervention with drug-eluting stents for patients with chronic renal failure on hemodialysis. Ann Thorac Surg 2010; 89(6): 1896-900.
[87]
Reddan DN, Szczech LA, Tuttle RH, et al. Chronic kidney disease, mortality, and treatment strategies among patients with clinically significant coronary artery disease. Am Soc Nephrol 2003; 14(9): 2373-80.
[88]
Rinehart AL, Herzog CA, Collins AJ, Flack JM. MA JL, Opsahl JA. A comparison of coronary angioplasty and coronary artery bypass grafting outcomes in chronic dialysis patients. Am J Kidney Dis 1995; 25(2): 281-90.
[89]
Crawford FA Jr, Selby JH Jr, Bower JD, Lehan PH. Coronary revascularization in patients maintained on chronic hemodialysis. Circulation 1977; 56(4 Pt 1): 684-7.
[90]
Agirbasli M, Weintraub WS, Chang GL, et al. Outcome of coronary revascularization in patients on renal dialysis. Am J Cardiol 2000; 86(4): 395-9.
[91]
Zheng H, Xue S, Lian F, Huang RT, Wang YY. Meta-analysis of clinical studies comparing coronary artery bypass grafting with percutaneous coronary intervention in patients with end-stage renal disease. Eur J Cardiothorac Surg 2013; 43(3): 459-67.
[92]
Opsahl JA, Husebye DG, Helseth HK, Collins AJ. Coronary artery bypass surgery in patients on maintenance dialysis: long-term survival. Am J Kidney Dis 1988; 12(4): 271-4.
[93]
Gruberg L, Dangas G, Mehran R, et al. Clinical outcome following percutaneous coronary interventions in patients with chronic renal failure. Catheter Cardiovasc Interv 2002; 55(1): 66-72.
[94]
Le Feuvre C, Dambriy G, Helft G, et al. Comparison of clinical outcome following coronary stenting or balloon anigioplasty in dialysis versus non-dialysis patients. Am J Cardiol 2000; 85(11): 1365-8.
[95]
Kuchulakanti PK, Torguson BS, Chu WW, et al. Impact of chronic renal insufficiency on clinical outcomes in patients undergoing percutaneous coronary intervention with sirolimus-eluting stents versus bare metal stents. Am J Cardiol 2006; 97(6): 792-7.
[96]
Tsai TT, Messenger JC, Brennan JM, et al. Safety and efficacy of drug-eluting stents in older patients with chronic kidney disease: a report from the linked CathPCI Registry–CMS claims database. J Am Coll Cardiol 2001; 58(18): 1859-69.
[97]
Das P, Moliterno DJ, Charnigo R, et al. Impact of drug-eluting stents on outcomes of patients with end-stage renal disease undergoing percutaneous coronary revascularization. J Invasive Cardiol 2006; 18(9): 405-8.
[98]
Yachi S, Tanabe K, Tanimoto S, et al. Clinical and angiographic outcomes following percutaneous coronary intervention with sirolimus-eluting stents versus bare-metal stents in hemodialysis patients. Am J Kidney Dis 2009; 54(2): 299-306.
[99]
Jeong YH, Hong MK, Lee CW, et al. Impact of significant chronic kidney disease on long-term clinical outcomes after drug-eluting stent versus bare metal stent implantation. Int J Cardiol 2008; 125(1): 36-40.
[100]
Halkin A, Selzer F, Marroquin O, Laskey W, Detre K, Cohen H. Clinical outcomes following percutaneous coronary intervention with drug-eluting vs. bare-metal stents in dialysis patients. J Invasive Cardiol 2006; 18(12): 577-83.
[101]
Nakazawa G, Tanabe K, Aoki J, et al. Impact of renal insufficiency on clinical and angiographic outcomes following percutaneous coronary intervention with sirolimus-oluting stents. Catheter Cardiovasc Interv 2007; 69(6): 804-14.
[102]
Aoyama T, Ishii H, Toriyama T, et al. Sirolimus-eluting stents vs bare metal stents for coronary intervention in Japanese patients with renal failure on hemodialysis. Circ J 2008; 72(1): 56-60.
[103]
Ishio N, Kobayashi Y, Takebayashi H, et al. Impact of drug-eluting stents on clinical and angiographic outcomes in dialysis patients. Circ J 2007; 71(10): 1525-9.
[104]
Mishkel GJ, Varghese JJ, Moore AL, Agguire F, Markwell SJ, Shelton M. Short-and long-term clinical outcomes of coronary drug-eluting stent recipients presenting with chronic renal disease. J Invasive Cardiol 2007; 19(8): 331-7.
Article Metrics
50
3