Thread by @ISNeducation

Check out this excellent review in @KIReports of a very important topic relevant to all clinicians involved in the care of CKD pts.

▶️Pts with CKD are at ⬆️sed risk of CAD with ⬇️ing eGFR
▶️Many CKD pts have atypical presentations of CAD; presenting more often with MI directly and more NSTEMI

▶️Risk stratification calculators like the Framingham criteria are inadequate and underestimate the risk in CKD pts
▶️Addition of eGFR/albuminuria/biomarkers can improve sensitivity but remains suboptimal
▶️Dialysis is an independent risk factor; ⬆️Sudden Cardiac Death⬆️CHF

▶️Screening in CKD cohort is traditionally done for symptomatic patients and asymptomatic high risk kidney transplant candidates.
Is it any different in your practice @VijayKher8 @silvishah @bthomas215 @BasuNephro @adjamali @kidneydoc101

▶️Functional testing & non-invasive imaging is a/w ⬇️sed accuracy in CKD
▶️Exercise testing is hampered by low functional capacity, esp in dialysis pts
▶️CT Angio has ⬆️sensitivity but ⬇️specificity; But Coronary Art Calcium Scores &SPECT have mod sensitivity&specificity

▶️Troponin levels are raised in CKD
▶️High sensitivity troponin I maintains sensitivity but loses specificity with ⬇️sing eGFR
💠All of this goes to show managing CAD in CKD pts isnt a walk in the park

▶️Increased risk of AKI due to Contrast exposure complicates things further in CKD 4/5ND
▶️We can limit damage by multiple options for eg limiting contrast volume using contrast vol/eGFR <1 Is this commonly used @ChristosArgyrop ?

▶️Or novel techniques like Ultra-low contrast angiography and "zero contrast percutaneous coronary intervention

▶️The problem with screening for CAD in transplant pts- can it do more harm by denying Tx to an asymptomatic pt?
▶️Death in this cohort is often due to non CAD causes like arrhythmias
▶️⬇️specificity/sensitivity for non-invasive screening tests
▶️Outcome benefits for revasc is ⬇️

Finally on the Q of Optimal medical therapy(OMT) vs invasive therapy for CAD in CKD pts the review discusses the recent ISCHEMIA-CKD study where randomised to either initial invasive therapy +OMT or OMT + SOS invasive therapy

All in all this comprehensive review is a must read. /Fin

Here's the link to the article that should have been at the top of the thread.. kireports.org/article/S2468-… Thanks @divyaa24