Unstable angina / non ST elevation myocardial infarction chronic kidney disease
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Overview of Chronic Kidney Disease in UA / NSTEMI
Chronic kidney disease(CKD) constitutes a risk factor for adverse outcomes after MI. It is a coronary artery disease equivalent as well as a risk factor for progression of CAD. There is limited evidence available on the management of UA/NSTEMI in this group due to their underrepresentaion in randomized trials. But limited evidence shows that cardiovascular medications and interventional strategies can be applied safely in those with renal impairment and provide therapeutic benefits. However, use of some of the medications and some strategies can be limited in the setting of ACS in these patients, bleeding complications are higher in this patient subgroup because of platelet dysfunction and dosing errors; benefits of fibrinolytic therapy, antiplatelet agents, and anticoagulants can be outweighed by bleeding complications; and use of renin angiotensin-aldosterone inhibitors can impose a greater risk because of the complications of hyperkalemia and worsening renal function in the CKD patient. Angiography carries an increased risk of contrast-induced nephropathy. A diagnosis of renal dysfunction is critical to proper medical therapy of UA/NSTEMI. Many cardiovascular drugs used in UA/NSTEMI patients are renally cleared; their doses should be adjusted for estimated creatinine clearance. Use of the Cockroft-Gault formula to generate dose adjustments is recommended.
In association with National Kidney Foundation, AHA advisory recommends that all patients with CAD be screened for evidence of kidney disease by estimating glomerular filtration rate, testing for microalbuminuria, and measuring the albumin-to creatinine ratio(Class IIa, Level of Evidence: C).
ACC / AHA Guidelines (DO NOT EDIT) [1][2]
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Class I1. Creatinine clearance should be estimated in UA / NSTEMI patients and the doses of renally cleared drugs should be adjusted appropriately. (Level of Evidence: B) 2. In patients with chronic kidney disease undergoing angiography who are not undergoing chronic dialysis, either an isosmolar contrast medium (Level of Evidence: A) or a low-molecular-weight contrast medium other than ioxaglate or iohexol is indicated. (Level of Evidence: B) |
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See Also
Sources
- The ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction [1]
- The 2009 ACC/AHA Focused update on the guidelines for STEMI and PCI[2]
References
- ↑ 1.0 1.1 Anderson JL, Adams CD, Antman EM; et al. (2007). "ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine". JACC. 50 (7): e1–e157. PMID 17692738. Text "doi:10.1016/j.jacc.2007.02.013 " ignored (help); Unknown parameter
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ignored (help) - ↑ 2.0 2.1 [1]