EURASIAN JOURNAL OF MEDICAL AND
NATURAL SCIENCES
Innovative Academy Research Support Center
IF = 7.921
Volume 5 Issue 8, August 2025 ISSN 2181-287X
Page 46
OPTIMIZATION OF OUTCOMES OF PERCUTANEOUS
CORONARY INTERVENTIONS IN PATIENTS WITH
CORONARY ARTERY DISEASE AND CHRONIC KIDNEY
DISEASE
Mahmudbekov M.O.
Scientific Advisor, Doctor of Medical Sciences, Professor:
Zufarov M.M.
The Republican Specialized Scientific and Practical Medical Center for
Surgery named after Academician V. Vakhidov
https://doi.org/10.5281/zenodo.16869265
ARTICLE INFO
ABSTRACT
Received: 08
th
August 2025
Accepted: 13
th
August 2025
Online: 14
th
August 2025
Coronary artery disease (CAD) and chronic kidney disease
(CKD) frequently coexist, particularly in elderly populations.
Their coexistence increases cardiovascular morbidity and
mortality due to complex pathophysiological interactions
such as accelerated atherosclerosis, endothelial dysfunction,
oxidative stress, and disturbances in water-electrolyte
balance. This study aims to optimize percutaneous coronary
intervention (PCI) outcomes in patients with CAD and CKD by
evaluating diagnostic approaches, procedural strategies, and
peri-procedural management. We retrospectively analyzed
100 patients with CAD and CKD who underwent PCI between
2022 and 2024 at the Republican Specialized Scientific-
Practical Medical Center of Surgery named after acad. V.
Vakhidov. Data included demographics, CKD stage
distribution, procedural details, and short-term outcomes.
The majority of patients (46%) were in CKD stage 3, with a
mean age of 64 years. PCI was associated with a high
procedural success rate (>95%), while contrast-induced
nephropathy (CIN) occurred in 9% of cases, predominantly in
advanced CKD stages. Conclusion: Optimizing PCI in CKD
patients requires a multidisciplinary approach, minimization
of contrast volume, and close monitoring of renal function.
Our findings support the integration of nephrology and
cardiology expertise to improve outcomes in this high-risk
group.
KEYWORDS
Percutaneous
coronary
intervention,
coronary
artery
disease,
chronic
kidney
disease,
cardiovascular
outcomes,
renal protection.
Introduction
Coronary artery disease (CAD) remains the leading cause of death worldwide, while
chronic kidney disease (CKD) is increasingly recognized as a major public health concern.
Epidemiological studies indicate that approximately 30–40% of patients with CKD also have
CAD, and up to 50% of CAD patients exhibit some degree of CKD. This coexistence results in
worse clinical outcomes due to shared risk factors such as hypertension, diabetes mellitus,
dyslipidemia, and systemic inflammation.
EURASIAN JOURNAL OF MEDICAL AND
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Volume 5 Issue 8, August 2025 ISSN 2181-287X
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The pathophysiology of CAD in CKD patients is multifactorial. In addition to traditional
atherosclerotic mechanisms, CKD-specific factors such as uremic toxins, altered calcium-
phosphate metabolism, and increased vascular calcification contribute to accelerated vascular
damage. Patients with CKD also present with altered platelet function and coagulation
abnormalities, increasing both thrombotic and bleeding risks.
Percutaneous coronary intervention (PCI) is a cornerstone of CAD management, offering
rapid revascularization and symptom relief. However, in CKD patients, PCI poses unique
challenges, including the risk of contrast-induced nephropathy (CIN), higher rates of restenosis,
and increased peri-procedural complications. Therefore, optimizing PCI strategies in CKD
patients requires a careful balance between procedural efficacy and renal protection.
Materials and Methods
This retrospective observational study included a total of 100 patients diagnosed with
both coronary artery disease (CAD) and chronic kidney disease (CKD) who underwent
percutaneous coronary intervention (PCI) between January 2022 and December 2024 at the
Republican Specialized Scientific-Practical Medical Center of Surgery named after acad. V.
Vakhidov. The study was approved by the institutional ethics committee, and informed consent
was obtained from all participants.
Inclusion criteria were: age greater than 18 years, angiographically confirmed CAD, and
CKD stages 2–5 according to Kidney Disease: Improving Global Outcomes (KDIGO)
classification. Exclusion criteria included acute kidney injury without chronic kidney disease,
active systemic infection, malignancy, recent major surgery (<3 months), and refusal to
participate.
Baseline assessment included a detailed clinical history, physical examination, and
cardiovascular risk profiling. Diagnostic procedures involved: electrocardiography (ECG),
transthoracic echocardiography (TTE) for left ventricular ejection fraction (LVEF)
measurement, and treadmill stress testing for ischemia detection. Laboratory investigations
included complete blood count (CBC), serum biochemistry (urea, creatinine, electrolytes, liver
enzymes), lipid profile, serum cardiac troponin I (cTnI), creatinine clearance via Roberg’s test,
brain natriuretic peptide (BNP), N-terminal pro-brain natriuretic peptide (NT-proBNP), and
coagulation profile.
All PCI procedures were performed by experienced interventional cardiologists using
standard techniques. The choice of vascular access (radial or femoral), type of stent (drug-
eluting stent [DES] or bare-metal stent [BMS]), and adjunctive pharmacotherapy (antiplatelet
agents, anticoagulants) was individualized based on clinical presentation, coronary anatomy,
and renal function status. Periprocedural hydration protocols were implemented in all patients,
using isotonic saline to reduce the risk of contrast-induced nephropathy (CIN). Contrast volume
was minimized according to patient risk, and iso-osmolar contrast media were preferred.
Patients undergoing chronic hemodialysis continued their sessions as per schedule, with
timing adjustments made for those undergoing PCI to optimize hemodynamic and metabolic
stability. Post-procedure, patients were closely monitored for renal function changes, access
site complications, and adverse cardiac events. Follow-up evaluations were scheduled at 1
month, 6 months, and 12 months after PCI, including clinical review, ECG, echocardiography,
and relevant laboratory tests.
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Results and Discussion
A total of 100 patients were included in the study, with a mean age of 64 years. The cohort
consisted of 62 males (62%) and 38 females (38%). The distribution of CKD stages revealed
that the majority of patients were in stage 3 (46%), followed by stage 4 (28%), stage 2 (18%),
and stage 5 (8%). The high proportion of stage 3 CKD underscores the prevalence of moderate
renal impairment among CAD patients undergoing PCI.
The procedural success rate for PCI was 96%, with 4 patients experiencing technical
failure due to complex coronary anatomy or severe calcification. The incidence of major
adverse cardiovascular and cerebrovascular events (MACCE) during the 12-month follow-up
was 12%, including myocardial infarction (5%), stroke (2%), and repeat revascularization
(5%). The mortality rate was 4%, primarily among patients with advanced CKD (stage 4–5).
Contrast-induced nephropathy (CIN) occurred in 9 patients (9%), with the highest
incidence in CKD stage 4 and 5 groups. Patients who received adequate pre-procedural
hydration and lower contrast volumes showed significantly lower rates of CIN. The use of iso-
osmolar contrast agents also contributed to a reduced risk of renal injury.
In terms of stent selection, drug-eluting stents (DES) were used in 78% of cases, while
bare-metal stents (BMS) were employed in 22% of cases. DES use was associated with a lower
rate of in-stent restenosis (4% vs. 10% in BMS), but prolonged dual antiplatelet therapy (DAPT)
increased the risk of bleeding in CKD patients. Balancing restenosis prevention with bleeding
risk remains a clinical challenge in this population.
Our findings align with previous research indicating that CAD patients with CKD
represent a high-risk group requiring individualized treatment strategies. The integration of
nephrology consultation during the peri-procedural period proved beneficial in managing renal
risk factors, optimizing fluid balance, and adjusting pharmacotherapy to minimize adverse
events.
Limitations of this study include its retrospective design, single-center nature, and
relatively small sample size. Nonetheless, the study provides valuable insights into optimizing
PCI outcomes in CAD patients with CKD, emphasizing the importance of a multidisciplinary
approach.
Table 1. Baseline Characteristics of the Study Population
Characteristic
Value
Total patients
100
Mean age
64 years
Male
62
Female
38
CKD Stage 2
18
CKD Stage 3
46
CKD Stage 4
28
EURASIAN JOURNAL OF MEDICAL AND
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Figure 1. Distribution of CKD Stages
Conclusions
Percutaneous coronary intervention (PCI) in patients with concomitant coronary artery
disease (CAD) and chronic kidney disease (CKD) can be performed with high procedural
success and acceptable complication rates when guided by an individualized, patient-centered
approach. The optimization of outcomes in this high-risk population requires a comprehensive
strategy that includes accurate patient selection, minimization of contrast volume, peri-
procedural renal protection measures, and meticulous post-procedural monitoring.
Our findings emphasize that the integration of multidisciplinary expertise—particularly
between cardiologists and nephrologists—plays a pivotal role in reducing complications,
preventing disease progression, and improving both short- and long-term survival rates.
Furthermore, the incorporation of contemporary guideline-directed medical therapy and
patient education are essential to achieving sustained benefits.
Future research should focus on large-scale, multicenter prospective studies to validate
these findings, refine PCI protocols for CKD patients, and explore novel pharmacologic and
interventional techniques that may further reduce the burden of adverse outcomes.
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Herzog CA, Asinger RW, Berger AK, et al. Cardiovascular disease in chronic kidney disease.
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Bangalore S, Maron DJ, O'Brien SM, et al. Management of Coronary Disease in Patients
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CKD Stage 5
8
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3.
Mehran R, Nikolsky E. Contrast-induced nephropathy: definition, epidemiology, and
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