Chronic kidney disease is an independent risk factor for coronary artery disease and patients with chronic kidney disease develop more complex and severe coronary artery lesions than patients without chronic kidney disease, specifically higher occurrence of multi-vessel disease, multiple diseased segments, diffuse or small vessel disease and long segment lesions. The progression of renal dysfunction is associated with increased severity of the coronary artery lesions, in addition to the characteristics mentioned in the previous sentence, higher occurrence of total occlusions and calcifications as well. Patients with concomitant diabetes mellitus may be expected to have more multi-vessel disease, diffuse or small vessel disease, calcifications and long segment lesions. With this in mind, patients with chronic kidney disease and coronary artery disease should be considered as very high risk for major adverse cardiovascular events and should be treated aggressively, especially in patients with mild renal dysfunction and normal renal function but at risk to develop kidney disease in order to avoid accelerated progression of the coronary artery disease which is associated with moderate to severe renal dysfunction.
Recommendations: Given this evidence, it is prudent to highly recommend screening of all patients with chronic kidney disease for cardiovascular risk factors and manage these patients aggressively, before the renal and cardiovascular diseases progress. For future studies, other methods such as intravascular ultrasound or coronary CT angiography may be considered to give more information about the vessel wall aside from quantifying the lesion complexity, as done in conventional coronary angiography.