Features March 2013 Issue

Heart Surgery May be Best to Treat CHD in Dialysis Patients

Research shows that stenting may not be as effective if you have multiple blockages in the arteries around the heart.

An estimated 30 to 60 percent of kidney failure patients on dialysis have coronary heart disease, a narrowing of the small arteries that supply blood to the heart. Arteries blocked with plaque can be opened with angiography and stenting or with coronary artery bypass grafting (CABG), which requires open surgery.

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Kidney failure and dialysis can complicate treatment options for coronary heart disease.

But when you have blockages in multiple arteries, and you’re on dialysis for your kidney failure, research shows that CABG is the safer option. That’s according on a study published recently in the Journal of the American Society of Nephrology.

“If you happen to be a dialysis patient with coronary heart disease in multiple vessels, going with bypass would better reduce your risk of a heart attack or death,”  says Cleveland Clinic nephrologist Joseph Nally, MD. Researchers found that CABG was associated with a 13 percent lower risk of death and a 12 percent lower risk of either dying or having a heart attack. The study looked at the outcomes of nearly 22,000 dialysis patients who underwent CABG or stenting between 1997 and 2009.

“Quite honestly, the enthusiasm a decade ago for angioplasty with stenting doesn’t appear to be as efficacious as CABG,” Dr. Nally says.
One of the reasons why treating dialysis patients is especially challenging is because these individuals tend to have other medical complications, such as hypertension, high cholesterol, and peripheral artery disease (PAD). Dialysis patients often tend have a higher risk of bleeding due to anticoagulation medications they take.

“For our dialysis patients, this research will help the doctor and patient make a more informed decision,” Dr. Nally says.