Revascularization Strategies in Chronic Kidney Disease: Percutaneous Coronary Interventions Versus Coronary Artery Bypass Graft

Both cardiovascular disease and chronic kidney disease are responsible for significant morbidity and mortality globally. Chronic kidney disease (CKD) is associated with the development and progression of atherosclerotic cardiovascular disease. In addition to traditional cardiovascular risk factors such as hypertension, smoking, diabetes mellitus, and hyperlipidemia, patients with CKD also carry nontraditional risk factors such as increased vascular calcification and myocardial fibrosis. In fact, patients with end-stage kidney disease are more likely to die from cardiovascular disease than renal dysfunction. However, unlike the general population, patients with CKD are less likely to receive evidence-based optimal medical therapy as well as revascularization therapy including percutaneous coronary intervention or coronary artery bypass graft. Currently, there are no high-quality data to guide the management of coronary artery disease in the CKD population. This chapter discusses the roles of revascularization with percutaneous coronary intervention and coronary artery bypass grafting and further compares their efficacies in patients with CKD based on current evidence in the literature.