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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.16869525
Relevance
Coronary artery disease (CAD) and chronic kidney disease (CKD) are two major
conditions frequently encountered in clinical practice, particularly among elderly patients.
According to multiple studies, approximately 30–40% of patients with CKD also suffer from
CAD, while up to 50% of CAD patients exhibit signs of CKD. CKD significantly increases the risk
of developing CAD, especially in advanced stages, where cardiovascular morbidity is 2–4 times
higher compared to individuals with normal renal function. Patients with concurrent CAD and
CKD often present with increased arterial hypertension, dyslipidemia, systemic inflammation,
water-electrolyte imbalance, and elevated liver and kidney enzyme levels. Performing
percutaneous coronary intervention (PCI) in such patients requires an integrated approach,
taking into account drug interactions, renal protection strategies, and careful monitoring of
blood pressure, serum urea, creatinine, and glucose. Despite the clinical importance, there is
still a lack of research focused on the impact of CKD on PCI outcomes, particularly in the Uzbek
population.
Objective
To improve outcomes and refine diagnostic strategies and PCI approaches in patients
with CAD and concurrent CKD.
Materials and Methods
The study included 100 patients diagnosed with CAD and CKD who underwent various
types of PCI at the Department of Interventional Cardiac Surgery of the Republican Specialized
Scientific-Practical Medical Center of Surgery named after acad. V. Vakhidov between 2022 and
2024. Diagnostic evaluation included ECG, echocardiography, treadmill stress testing,
laboratory tests (complete blood count, biochemical profile, serum cTnI, creatinine clearance
via the Robert test, natriuretic peptides BNP and NT-proBNP, and coagulation profile). Both
immediate and long-term outcomes were assessed, along with the role of hemodialysis therapy
in pre- and post-procedural management.
Results
Of the studied patients, 46% were in CKD stage 3, 28% in stage 2, 18% in stage 4, and 8%
in stage 5. The mean patient age was 64 years. PCI success rates exceeded 95%, with contrast-
induced nephropathy (CIN) occurring in 9% of cases, predominantly among those with
advanced CKD stages. Hemodialysis was required in 6% of patients post-PCI, primarily in stage
5 CKD. The study identified key risk factors for CKD exacerbation after PCI, including high
contrast volume, pre-existing anemia, and uncontrolled hypertension.
Conclusion
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PCI in patients with CAD and CKD presents significant challenges due to the increased risk
of renal complications and cardiovascular events. Optimization of outcomes requires a
multidisciplinary approach involving both cardiologists and nephrologists, minimization of
contrast use, individualized peri-procedural care, and strict post-procedural monitoring. The
developed diagnostic and interventional algorithm can improve patient prognosis and quality
of life, especially in the Uzbek population where specific clinical characteristics may influence
outcomes.
References:
Используемая литература:
Foydalanilgan adabiyotlar:
1.
Go AS, Chertow GM, Fan D, et al. Chronic kidney disease and the risks of death,
cardiovascular events, and hospitalization. N Engl J Med. 2004;351(13):1296-1305.
2.
Leon MB, Baim DS, Popma JJ, et al. A clinical trial comparing three antithrombotic-drug
regimens after coronary-artery stenting. N Engl J Med. 1998;339(23):1665-1671.
3.
McCullough PA, Wolyn R, Rocher LL, et al. Acute renal failure after coronary intervention:
incidence, risk factors, and relationship to mortality. Am J Med. 1997;103(5):368-375.
4.
National Kidney Foundation. KDOQI Clinical Practice Guidelines for Chronic Kidney
Disease. Am J Kidney Dis. 2002;39(2 Suppl 1):S1-S266.
