Ferric citrate for the treatment of hyperphosphatemia and anemia in patients with chronic kidney disease: a meta-analysis of randomized clinical trials

BackgroundHyperphosphatemia and anemia, which are common complications of chronic kidney disease (CKD), can independently contribute to cardiovascular events. Several previous studies have found that the iron-based phosphate binder, ferric citrate (FC), could be beneficial to both hyperphosphatemia and anemia.MethodsRelevant literature from PUBMED, EMBASE, the Cochrane Central Register of Controlled Trials (CCRCT) and MEDLINE databases were searched up to 21 February 2022, in order to conduct a meta-analysis to investigate the efficacy, safety and economic benefits of ferric citrate treatment in CKD patients with hyperphosphatemia and anemia. The meta-analysis was conducted independently by two reviewers using the RevMan software (version 5.3).ResultsIn total, this study included 16 randomized clinical trials (RCT) involving 1754 participants. The meta-analysis showed that ferric citrate could significantly reduce the serum phosphorus in CKD patients compared to the placebo control groups (MD −1.76 mg/dL, 95% CI (−2.78, −0.75); p = 0.0007). In contrast, the difference between ferric citrate treatment and active controls, such as non-iron-based phosphate binders, sevelamer, calcium carbonate, lanthanum carbonate and sodium ferrous citrate, was not statistically significant (MD − 0.09 mg/dL, 95% CI (−0.35, 0.17); p = 0.51). However, ferric citrate could effectively improve hemoglobin levels when compared to the active drug (MD 0.43 g/dL, 95% CI (0.04, 0.82); p = 0.03) and placebo groups (MD 0.39 g/dL, 95% CI (0.04, 0.73); p = 0.03). According to eight studies, ferric citrate was found to be cost-effective treatment in comparison to control drugs. Most of the adverse events (AE) following ferric citrate treatment were mild at most.ConclusionCollectively, our review suggests that iron-based phosphate binder, ferric citrate is an effective and safe treatment option for CKD patients with hyperphosphatemia and anemia. More importantly, this alternative treatment may also less expensive. Nevertheless, more scientific studies are warranted to validate our findings.     

Regulation of parathyroid function in chronic kidney disease (CKD)

In chronic kidney disease (CKD), several abnormalities in bone and mineral metabolism develop in the majority of patients. The parathyroid plays a very important role in regulating bone and mineral metabolism; thus, control of parathyroid function is one of the main targets of the management of CKD-mineral and bone disorder (CKD-MBD). In the development of secondary hyperparathyroidism, it has recently been suggested that fibroblast growth factor 23 (FGF23) plays a crucial role, both as a phosphaturic factor and as a suppressor of active vitamin D (1,25D) production in the kidney. FGF23 is originally secreted to prevent hyperphosphatemia in CKD, but this occurs at the expense of low 1,25D and hyperparathyroidism (“trade-off” hypothesis revisited). Furthermore, recent data suggest that FGF23 could be another useful marker for the prognosis of hyperparathyroidism, because a high serum level may reflect the cumulative dose of vitamin D analogues previously administered. We have also demonstrated that severe hyperparathyroidism was associated with the production and secretion of a new form of parathyroid hormone (PTH) molecule, which can be detected by third-generation assays for PTH, but not by the second-generation assays. For the regression of already established nodular hyperplasia, the more advanced type of parathyroid hyperplasia, it is certainly necessary, in the near future, to develop new agents that specifically induce apoptosis in parathyroid cells. Until such agents are developed, prevention and early recognition of nodular hyperplasia is mandatory for the effective and safe management of hyperparathyroidism in CKD.     

碳酸镧联合不同血液净化方式对慢性肾脏病-矿物质和骨代谢异常患者钙磷代谢的影响

目的探讨碳酸镧联合不同血液净化方式对慢性肾脏病-矿物质和骨代谢异常(chronic kidney disease mineral and bone disorder,CKD-MBD)患者钙磷代谢的影响,为CKD-MBD患者选择最佳治疗方案,改善患者的生存质量。方法选择陕西省人民医院2014年1月至2015年5月行维持性血液透析的CKD-MBD患者76例,给予口服碳酸镧并按透析方式分为3组,血液透析(hemodialysis,HD)组24例、血液透析联合血液透析滤过(HD and hemodialysis filtration,HD+HDF)组27例,血液透析联合血液灌流(HD and blood perfusion,HD+HP)组25例,比较各组治疗前和治疗3个月后血钙、血磷、钙磷乘积及甲状旁腺素(parathyroid hormone,PTH)的变化。观察3组治疗中不良反应的发生率并进行比较。结果治疗3个月后,3组血钙较治疗前均升高,3组间血钙变化无统计学差异(P0.05);3组血磷及钙磷乘积较治疗前明显下降(P0.05),但HD+HDF组、HD+HP组较HD组下降更为明显(P0.05)。HD组门H在治疗前、后变化不大(P0.05),HD+HDF组和HD+HP组治疗3个月后PTH较前明显下降(P0.05)。HD组、HD+HDF组及HD+HP组患者并发症发生率分别为75.0%、18.5%、32.0%,HD组并发症明显高于HD+HDF组和HD+HP组,差异有统计学意义(P0.05),HD+HDF组并发症发生率最低。结论碳酸镧联合不同血液净化方式对血钙、血磷及PTH的清除效果不同,联合HDF和HP方式能明显清除血磷、PTH,改善钙磷代谢紊乱,不良反应小,适合临床应用治疗CKD-MBD。     

High on-clopidogrel platelet reactivity and chronic kidney disease: a meta-analysis of literature studies

Background. The efficacy of clopidogrel is often attenuated in the setting of renal impairment. High on-treatment platelet reactivity (HPR) is an independent correlate of adverse event. Here we performed a quantitative evaluation of the prevalence and impact of HPR in patients with chronic kidney disease (CKD). Methods. We systematically searched PubMed, EMBASE and the Cochrane Library from their inception to 1 March 2018 for cohort studies assessing the risk ratio (RR) of prevalence of HPR in CKD versus non-CKD patients and association of cardiovascular outcome with HPR in CKD patients treated with clopidogrel. Outcome measures included major adverse cardiac event, myocardial infarction and stent thrombosis. RRs and 95% confidence intervals (CIs) were used as estimates of effect size in random-effect models. Results. Ten studies comprising a total of 3028 CKD patients and 11138 non-CKD patients were included in the evaluation. Compared to patients with normal renal function, patients with CKD had a significantly higher risk of HPR (OR: 1.34, 95% CI: 1.23–1.46). In CKD patients, HPR was associated with increased risk of MACE (RR 2.99, 95% CI 1.19 to 7.53; p?p?=?0.0002), and stent thrombosis (RR 2.98, 95% CI 1.42 to 6.26; p?=?0.004). Conclusions. Based on pooled analysis, CKD appeared correlated with HPR and this association had prognostic significance. Further studies with standardised laboratory methods and specifically defined protocols are required to validate the clinical relevance of such response variability to clopidogrel in CKD patients.     

血红蛋白靶目标值对慢性肾脏病患者生存影响的荟萃分析

目的 探讨血红蛋白(Hb)水平对慢性肾脏病(CKD)患者生存时间的影响,为明确CKD患者最佳Hb靶目标值提供参考依据.方法 采用荟萃分析的方法,利用Medline、Embase和Cochrane数据库检索国内外公开发表的有关Hb水平对CKD患者生存影响的临床试验,通过Cochrane协作网提供的Revman软件对检索结果进行荟萃分析.结果 纳入本次荟萃分析的文献共23篇,随访样本总量10 204例.综合分析后发现,与低Hb(Hb＜100 g/L)水平组患者相比,维持高Hb(Hb＞127 g/L)水平可增加患者死亡及发生高血压、中风及住院治疗的风险,相对危险度(RR)值分别为1.10、1.40、1.73和1.07,两组比较差异均有统计学意义(P＜ 0.05).但两组非致命性心肌梗死(RR=1.13,95％CI 0.79～1.62)及肾脏替代治疗(RR=1.00,95％CI 0.85～1.18)的发生率差异均无统计学意义.结论 在纠正CKD患者贫血过程中,维持低Hb水平可以降低患者发生高血压、中风、入院治疗和死亡的风险,但不能改善心肌梗死发生及肾脏替代治疗的风险.     

Effectiveness of thiazide and thiazide-like diuretics in advanced chronic kidney disease: a systematic review and meta-analysis

Background and objectiveThiazide diuretics are first-line drugs for the treatment of hypertension, but hypertension treatment guidelines have systematically discouraged their use in patients with advanced chronic kidney disease (CKD). For the first time, a systematic review and random-effects meta-analysis were performed to assess the effectiveness of thiazides and thiazide-like diuretics to treat hypertension in patients with stages 3b, 4, and 5 CKD.Design, setting, participants, & measurementsA systematic review and random-effects meta-analysis that included a literature search using the following databases were performed: MEDLINE through PubMed, Cochrane Database of Systematic Reviews (CDSR) and Cochrane Central Register of Controlled Trials (CENTRAL) through the Cochrane Library, Embase, and ISI – Web of Science (all databases). Prospective studies that evaluated the effectiveness of thiazide and thiazide-like diuretics in individuals with a GFR < 45 mL/min/1.73 m² were included.ResultsFive clinical trials, totaling 214 participants, were included, and the mean GFR ranged from 13.0 ± 5.9 mL/min/1.73 m² to 26.8 ± 8.8 mL/min/1.73 m². There was evidence of a reduction in mean blood pressure and in GFR, as well as in fractional sodium excretion and fractional chloride excretion.ConclusionThiazide and thiazide-like diuretics seem to maintain their effectiveness in lowering blood pressure in patients with advanced chronic kidney disease. These findings should spur new prospective randomized trials and spark discussions, particularly about upcoming hypertension guidelines.     

Pseudoexfoliation syndrome in chronic kidney disease patients

Abstract

This study was performed to determine whether chronic kidney disease (CKD) is associated with an increased risk of pseudoexfoliation (PEX) syndrome. This is an age-matched case control study evaluating frequency of PEX in patients over age 40 with the diagnosis of stage 1–4 CKD and those undergoing hemodialysis (HD). Subjects over age 40 with hypertension and/or diabetes mellitus (DM) and normal kidney functions were studied as a control group. CKD was diagnosed as decreased glomerular filtration rate (GFR) of less than 60?mL/min/1.73?m² for at least 3 months. Study groups were arranged as group 1 consisting of HD receiving CKD patients, group 2 consisting of CKD patients who do not need HD and group 3 as a control. Demographic properties and the prevalence of PEX were evaluated and compared between groups. Because of the effect of DM on PEX occurrence, it was also evaluated after exclusion of diabetic patients. A total of 101 cases in group 1, 106 cases in group 2 and 117 cases in group 3 were included in the study. Pseudoexfoliation was found in 7 (6.9%) patients in group 1, 5 (4.7%) patients in group 2 and 7 (5.9%) patients in group 3 (p?>?0.05). After exclusion of diabetic patients the prevalence of PEX changed as 4 (5.6%) in group 1, 2 (4.4%) in group 2 and 1 (1.8%) in group 3 (p?>?0.05). In conclusion, CKD was not associated with increased prevalence of PEX in this study.     

碳酸镧与传统磷结合剂治疗维持性血液透析患者高磷血症的Meta分析

目的 评价碳酸镧与传统磷结合剂治疗维持性血液透析患者高磷血症的疗效和安全性.方法 计算机检索MEDLINE(1996-2012.12)、EBCO (1996-2012.12)、Cochrane图书馆临床对照试验资料库和中文万方数据库(1996-2012.12).手工检索已发表或未发表的相关文献,包括会议摘要等.检索无语种限制.纳入碳酸镧与传统磷结合剂比较治疗维持性血液透析患者高磷血症的随机对照试验.由两名评价员独立评价纳入研究的质量和提取资料,并用RevMan 5.0软件进行Meta分析.结果 共纳入10项研究.Meta分析结果显示,碳酸镧与传统磷结合剂相比,降低血磷水平的疗效差异无统计学意义[WMD=-0.06,95％ CI(-0.27～0.15),P=0.57],但碳酸镧治疗组血钙水平低于含钙磷结合剂,两组间因不良反应退出情况差异无统计学意义,碳酸镧治疗组高钙血症发生率低于传统磷结合剂.结论 碳酸镧治疗对终末期肾脏疾病维持性血液透析患者高磷血症有效,且其高钙血症发生率低于传统磷结合剂.     

Care of elderly patients with chronic kidney disease

Background Providing optimal care to the growing number of chronic kidney disease (CKD) patients remains a significant problem in the United States. There is little known about the care of elderly CKD patients by primary care physicians as well as nephrologists. Methods We performed a retrospective study of 377 elderly male CKD (serum creatinine >1.4 mg/dl on 2 separate occasions 3 months apart) patients referred to the Nephrology Clinic at the Buffalo Veterans Administration Medical Center between 1999 and 2002 to see if the pattern of care changed during this time. Results The mean age of the patients was 75.9 years. Eighty-four percent were Caucasian, 15% were African-American, and 1% were of other race. Etiology of CKD included hypertensive nephrosclerosis (49%), diabetic nephropathy (23%), renovascular disease (18%), and others (10%). Sixty-five percent of patients had estimated glomerular filtration rate (eGFR) >30 ml/min. Overall angiotensin converting enzyme inhibitor (ACEI) was used in 51% of patients with CKD, and in 63% of patients with diabetic nephropathy. Twenty percent of patients had a hemoglobin <11 g/dl, darbepoietin/epogen was used in 31% of these patients. Screening for kidney related tests were done infrequently while lipid profile and hemoglobin A1C were done in the majority of patients because of clinical reminders in the VA computerized patient record system (CPRS). Conclusion These results emphasize the need for increased education of primary care physicians and nephrologists to improve the care of elderly CKD patients. Although there was a trend towards earlier referral, care did not change significantly between years 1999 and 2002.     

Safety of total dose iron dextran infusion in geriatric patients with chronic kidney disease and iron deficiency anemia

There are limited data on total dose infusion (TDI) using iron dextran in geriatric chronic kidney disease (CKD) patients with iron-deficiency anemia (IDA). Our goal was to evaluate the safety of TDI in this setting. We conducted a retrospective chart review spanning a 5 year period (2002–2007), including all patients with CKD and IDA who were treated with iron dextran TDI. Patient demographics were noted, and laboratory values for creatinine, hemoglobin and iron stores were recorded pre- and post-dose. TDI diluted in normal saline was administered intravenously over 4-6 hours after an initial test dose. One hundred fifty-three patients received a total of 250 doses of TDI (mean?±?SD?=?971?±?175?mg); age was 69?±?12 years and creatinine 3.3?±?1.9?mg/dL. All stages of CKD were represented (stage 4 commonest). Hemoglobin and iron stores improved post-TDI (P?P?=?0.1433 by Fishers Exact Test). Iron dextran TDI is relatively safe and effective in correcting IDA in geriatric CKD patients. Fewer AEs were noted with the LMW compared to the HMW product. LMW iron dextran given as TDI can save both cost and time, helping to alleviate issues of non-compliance and patient scheduling.     

A systemic review and meta-analysis on the efficacy and safety of ferumoxytol for anemia in chronic kidney disease patients

PurposeTo evaluate the efficacy of ferumoxytol, relative to conventional iron supplement formulations, on hemoglobin levels, ferritin level, and adverse event incidence in chronic kidney disease patients.MethodsWe performed a systematic search of six academic databases (EMBASE, CENTRAL, Scopus, PubMed, Web of sciences, and MEDLINE), adhering to PRISMA guidelines. We performed a meta-analysis on relevant studies to evaluate the overall influence of ferumoxytol, relative to conventional iron supplement formulations, on hemoglobin levels, ferritin level, and treatment related treatment emergent adverse events (TEAEs) incidence in chronic kidney disease patients.ResultsSeven eligible studies were identified from a total of 1397 studies. These studies contained data on 3315 participants with chronic kidney disease (mean age: 59.2 ± 4.6 years). A meta-analysis revealed that ferumoxytol administration had positive effects on hemoglobin levels (Hedge’s g statistic: 0.51) and ferritin level (0.88), transferrin saturation (0.39). Besides, we also report reduced incidence of treatment related TEAEs (−0.24) for patients consuming ferumoxytol as compared conventional iron supplement formulations.ConclusionsThis meta-analysis provides preliminary evidence that ferumoxytol use exerts beneficial effects on the overall hematological outcomes in patients with chronic kidney disease. This study also reports improved treatment related safety profile for ferumoxytol when compared with conventional iron formulations. The findings from this study can have direct implications in forming best practice guidelines for managing anemia in patients with chronic kidney disease.     

A Meta - analysis of lanthanum carbonate for hyperphosphatemia in end - stage renal disease

Objective To assess the efficacy and safety of lanthanum carbonate in treatment of hyperphosphatemia in end-stage renal disease（ESRD）. Methods Randomized controlled trails of lanthanum carbonate in treatment of hyperphosphatemia in ESRD patients were searched in the database of MEDLINE,Cochrane Central Register of Controlled Trials, EMBASE, CNKI, Wanfang database. Data extracted from the literatures were analyzed with the Cochrane Collaboration’s RevMan 5.1 software. Results Lanthanum carbonate group was similar with calcium carbonate group in treating hyperphosphatemia[RR=1.00, 95％CI (0.92-1.09), P=0.97], and more effective than placebo [RR=4.69, 95％ CI (2.63 - 8.39), P＜0.01] (intervention dose≤1500 mg) and [RR=18.92, 95％ CI (7.42-48.22), P＜0.01] (intervention dose＞1500 mg). In comparison with calcium carbonate group, the incidence of hypercalcinemia of lanthanum carbonate group was lower [RR=0.06, 95％CI (0.01-0.72), P=0.03],while the incidence of nausea [RR=1.80, 95％CI (0.70-4.64), P=0.22], vomiting [RR=3.94,95％ CI (0.45 - 34.38), P=0.22] and constipation [RR=0.82, 95％ CI (0.49 - 1.37), P=0.45] were similar. The incidence of nausea and vomiting of lanthanum carbonate group were similar with placebo, with lower incidence of constipation [RR=0.19, 95％ CI (0.06-0.59), P＜0.01]. Conclusions The efficacy of lanthanum carbonate in treating hyperphosphatemia is similar with calcium carbonate. The incidence of hypercalcinemia of lanthanum carbonate is lower than that of calcium carbonate, and the incidence of gastrointestinal adverse effect such as nausea, vomiting and constipation are similar with calcium carbonate.     

Uremic toxicity and sclerostin in chronic kidney disease patients

Background and aimsSclerostin is a circulating inhibitor of the Wnt/β-catenin pathway and may have a role in chronic kidney disease (CKD)-mineral and bone disorder. Blood sclerostin levels are known to be elevated in patients undergoing maintenance dialysis. The aims of the present study were to evaluate sclerostin levels in patients at different CKD stages and study potential associations between sclerostin levels and (i) biochemical parameters that are disturbed in CKD, (ii) markers of vascular disease and (iii) mortality.MethodsOne hundred and forty patients at CKD stages 2-5D were included in the present study. Routine clinical biochemistry tests and assays for sclerostin, protein-bound uremic toxins (indoxylsulphate [IS] and p-cresyl sulphate [PCS]) and the toxin β2 microglobulin (β2M) were performed. Aortic and coronary calcification and arterial stiffness were assessed by multislice spiral computed tomography and pulse wave velocity measurements. The enrolled patients were prospectively monitored for mortality.ResultsSclerostin levels were found to be elevated in CKD patients (especially those on hemodialysis). Furthermore, sclerostin levels were positively correlated with inflammation markers, phosphate, fibroblast growth factor 23, IS, PCS, β2M and arterial stiffness. A multivariate linear regression analysis indicated that sclerostin levels were independently associated with IS, PCS and β2M levels. Elevated serum sclerostin appeared to be associated with mortality (independently of age and inflammation). However, this association disappeared after adjustment for a propensity score including age, phosphate, interleukin-6, CKD stage and PCS.ConclusionOur results indicate that sclerostin levels are elevated in CKD patients and are associated with inflammation, vascular lesions, uremia and (potentially) mortality.     

慢性肾脏病患者高尿酸血症的管理

生理情况下,人体每日尿酸的产生和排泄基本上保持动态平衡。若血清尿酸水平男>420 μmol/L,女>360 μmol/L则称为高尿酸血症。随着居民生活方式、饮食结构的改变以及人口老龄化,高尿酸血症的发病率呈逐年上升趋势。越来越多的研究表明高尿酸血症与慢性肾脏病(CKD)的关系密切。尿酸是嘌呤核苷酸代谢中不易溶解的循环终产物,CKD患者肾小球滤过率降低时,高尿酸血症发生的风险增加,而长期的高尿酸血症会导致肾功能的进行性恶化,增加患者心血管疾病的发生风险及死亡率。因此做好CKD患者高尿酸血症的管理具有重要的临床意义。关于高尿酸血症诊断和治疗有多项专家共识和指南,即改善生活方式是治疗的基础,早期干预和综合管理是治疗的核心。     

南京市江宁地区慢性肾脏病就诊原因分析

目的 分析南京市江宁地区肾内科就诊人群的就诊原因,了解慢性肾脏病知识在该地区的普及状况.方法 调查我院肾内科2012年12月至2013年12月的门诊日志,分别统计首次就诊人群及复诊人群的构成及就诊原因.结果 2012年12月至2013年12月我院肾内科共有4 226人次就诊,其中首次就诊人群2 015人次,复诊患者2 211人次.首次就诊人群就诊原因中,浮肿791人次,腰痛和(或)腰酸352人次,尿路刺激症状247人次,尿检异常215人次,糖尿病肾病105人次(其中临床蛋白尿76人次,微量白蛋白尿29人次),终末期肾病61人次,其他原因244人次.复诊人群就诊原因中慢性肾功能不全(包括终末期肾病血液透析及腹膜透析患者)720人次,糖尿病肾病615人次,慢性肾炎527人次.其他就诊原因349人次.讨论 我院肾科首次就诊患者多为有临床症状者,因体检发现血尿、蛋白尿就诊者较少;复诊患者主要为慢性慢性肾功能衰竭、糖尿病肾病及慢性肾炎.慢性肾脏病的早期诊治明显欠缺,提示我区肾脏病知识的普及、宣传工作尚需进一步加强.而我区几年前开始施行的糖尿病免费政策,可能是导致糖尿病肾病明显多于慢性肾炎的原因.     

非透析慢性肾脏病患者高尿酸血症的危险因素分析

目的 探讨和分析非透析慢性肾脏病(non-dialysis chronic kidney disease,ND-CKD)患者高尿酸血症(hyperuricemia,HUA)的发生率及其相关危险因素.方法 收集2015年1月至2019年12月于山西医科大学第二医院肾内科就诊的540例ND-CKD患者的临床资料,依据HUA...     

Sleep quality and its correlates in patients with chronic kidney disease: a cross-sectional design

Abstract

Purpose: Since sympathovagal imbalance influences clinical phenomena, such as hypertension, diabetes mellitus, chronic kidney disease (CKD) and sleeping problems, there should be correlations between these conditions. We hypothesized that sleep quality would be correlated with estimated glomerular filtration rate (eGFR), blood pressure and the presence of diabetes. Methods: We included 303 CKD patients in this study. We employed the Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI) and Short Form 36 Quality of Life Health Survey Questions (SF-36) to screen sleeping disturbances, depression and quality of life, respectively. A chart review was performed for the patients' demographics, diagnoses and certain laboratory parameters—including blood glucose, hemoglobin, albumin, calcium, phosphate, parathyroid hormone and eGFR. Multivariate logistic regression models were employed to estimate odds ratios with 95% confidence intervals. Results: We included 303 patients in this cross-sectional study. A total of 101 patients were on dialysis. In the univariate models, gender, calcium and mental component summary scores (MCS) reached a significant level of 0.1, and those covariates were included in the multivariate analysis. The reduced models included gender and MCS categories. Female gender increases the risk for poor sleep quality. In our report, evidence suggests MCS domain scores are inversely related to the risk for impaired sleep. Conclusion: Our results indicated a high burden of sleep disturbances in kidney patients. In addition, female gender and having low MCS scores may influence sleep quality in kidney patients.     

Optimal timing of coronary angiograms for patients with chronic kidney disease: association between the duration of kidney dysfunction and SYNTAX scores

BackgroundChronic kidney disease (CKD) is associated with an increased risk of the progression of coronary artery disease (CAD). However, there are few data on the relationship between CAD severity and the duration of CKD. This study assessed the predictive value of the duration of kidney dysfunction in CKD patients with CAD severity.MethodsIn 145 patients (63.4% male, n = 92; mean age, 68.8 ± 12.8 years) with CKD, severity of CAD was assessed by coronary angiography and quantified by SYNTAX scores, and duration of kidney dysfunction was either assessed by checking historical biochemical parameters of individuals or was based on enquiries.ResultsPatients with high SYNTAX scores (≥ 22) had a greater prevalence of cardiovascular risk factors including age, gender, history of heart failure and smoking. In CKD patients, SYNTAX scores were positively correlated to duration of CKD and serum uric acid (UA), and negatively correlated to high-density lipoprotein-cholesterol (HDL-C) and ApoA1 levels. Univariate binary logistic regression and multivariate logistic analyses showed that SYNTAX scores correlated significantly with CKD duration, UA, and HDL-C. Receiver-operating characteristic analysis was used to explore a time point when coronary angiography application was economical and effective and yielded a Youden index of 6.5 years.ConclusionsTogether, our results demonstrated that the duration of kidney dysfunction was an independent correlate of the severity of CAD in patients with CKD. Our findings suggest that coronary angiography should be considered for CKD patients with renal insufficiency having lasted for more than 6.5 years.     

Percutaneous coronary intervention compared with coronary artery bypass graft in coronary artery disease patients with chronic kidney disease: a systematic review and meta-analysis

Previous reports of percutaneous coronary intervention versus coronary artery bypass graft outcomes in coronary artery disease patients with chronic kidney disease (CKD) were inconsistent. We evaluated the optimal revascularization strategy for CKD patients. We searched Pub Med, EMBASE, and the Cochrane Central Register of Controlled Trials and scanned the references of relevant articles and reviews. All studies that compared relevant clinical outcomes between percutaneous coronary intervention and coronary artery bypass graft in CKD patients were selected. We defined short-term and long-term all-cause mortality as primary outcome, and long-term incidences of myocardial infarction and revascularization as secondary outcomes. A total of 2235 citations were retrieved, and 31 studies involving 99,054 patients, with 55,383 receiving percutaneous coronary intervention and 43,671 receiving coronary artery bypass graft, were included. In subgroup analyses of dialysis patients receiving percutaneous coronary intervention with stents versus coronary artery bypass graft, CKD patients with multivessel coronary disease, and CKD patients receiving drug-eluting stent versus coronary artery bypass graft, the pooled outcomes revealed that percutaneous coronary intervention possessed lower short-term mortality, but higher late revascularization risk. No significant differences in long-term mortality were observed between the two strategies in these subgroup analyses. In conclusion, in some specific clinical circumstances, CKD patients receiving percutaneous coronary intervention possessed lower short-term all-cause mortality, but higher long-term revascularization risk, than coronary artery bypass graft; long-term all-cause mortality was not different between the two strategies.