Benefits and Harms of Coronary Revascularization in Non-Dialysis-Dependent CKD and Ischemic Heart Disease: A Systematic Review and Meta-Analysis

Abstract

tweigh benefits of revascularization. Evidence on the balance of these risks and benefits, specifically in people with non-dialysis-dependent CKD, is lacking. Methods: We conducted a systematic review of randomized controlled trials (RCTs) to assess the risks and benefits of revascularization, compared to medical management, among adults or children with ischemic heart disease and CKD not requiring kidney replacement therapy (dialysis or transplantation). We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) through December 12th, 2023. Two people independently screened titles and abstracts followed by full-text review, serially extracted data using standardized forms, independently assessed risk of bias, and graded the certainty of evidence (COE). Results: Evaluating data from nine RCTs, we found that people with CKD and ischemic heart disease treated with revascularization may experience lower all-cause mortality compared to people receiving medical management (RR 0.80, 95% CI 0.64-0.98; COE, low). Revascularization may reduce incidence of myocardial infarction (RR 0.81, 95% CI 0.64-1.04; COE, low) and heart failure (RR 0.80, 95% CI 0.52-1.23; COE, low). The effect on cardiovascular mortality is uncertain (HR 0.67, 95% CI 0.37-1.20; COE, very low). Evidence was insufficient for patient-reported outcomes and adverse kidney events. Data were limited by heterogeneity of patient populations and the limited number of trials. Conclusions: In people with non-dialysis-dependent CKD, revascularization may be associated with lower all-cause mortality compared to medical management and may also lower the risk of cardiovascular events. Additional data surrounding kidney and patient-reported outcomes are needed to comprehensively engage in shared decision making and determine optimal treatment strategies for people with CKD and ischemic heart disease. Copyright © 2024 by the American Society of Nephrology...