For patients with end-stage kidney disease (ESKD) undergoing dialysis, both hemodialysis (HD) and peritoneal dialysis (PD), the clustering of traditional and non-traditional risk factors drives an excess rate of coronary artery disease (CAD). The incidence, severity and mortality of CAD, as well as the number of complications of therapy, are higher in dialysis patients than in non-ESKD disease population.
ESKD patients with CAD are more likely to be asymptomatic compared with those with CAD and preserved kidney function. This can hinder the correct identification of CAD and the appropriate risk stratification and management, potentially resulting in worse outcomes. Moreover, hemodialysis (HD) treatment may also promote or worsen myocardial damage while promoting arrhythmias due to rapid changes in electrolyte balance. Moreover, in PD patients accelerated atherosclerosis processes are actively present. Due to the absence of randomized controlled trials, evidence on the ideal therapeutic strategy for ESKD population with CAD is lacking. Indeed, current practice is mainly based on observational data that are subject to potential bias. Current guidelines are either lacking for HD patients or are derived from trials performed in non-HD patients. Specifically, the risks and benefits of antiplatelet agents in ESKD patients with CAD remain poorly defined; the optimal revascularization strategy for these patients remains unclear.
The purpose of this special issue is to address the complex and unresolved aspects of diagnosis, prevention, and treatment of CAD in HD patients, with respect to both acute coronary syndromes and chronic ischemic heart disease.
Narrative or systematic reviews of data available in the literature as well as original studies addressing the issues illustrated above are welcome.
Prof. Simonetta Genovesi and Dr. Giuseppe Regolisti
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