Chronic Kidney Disease

A new study exams the effects of intravascular ultrasound (IVUS) guide drug eluting stent (DES) implantation on patients with Chronic Kidney Disease (CKD). Results show that CKD patients treat with IVUS-guided DES implantation had better outcomes compared to those who received the traditional angiography guidance DES implantation at the 12-month mark.

The prespecific subgroup analysis of the prospective, multicenter; so randomize ULTIMATE trial is schedule to be present on Wednesday; so May 22 as late-breaking clinical research at the Society for Cardiovascular Angiography and Interventions (SCAI) 2019 Scientific Sessions.

Worldwide health issue

Chronic kidney disease is a growing worldwide health issue affecting one in ten individuals; hence according to the National Kidney Foundation. Patients with CKD are more than 30% likely to have cardiovascular disease; which is the leading cause of death, according to the National Institutes of Health.

While several randomize trials and observational studies; which have establish the clinical benefits of IVUS-guided DES implantations for patients with complex lesions; so the treatment option remains controversial for patients with CKD due to longer procedural time and perceive potential risks of acute renal failure and atheroembolism.

The present study, which was a pre specify subgroup analysis of the ULTIMATE trial; hence was design to explore the impacts of IVUS-guide second-generation DES implantations on patients with CKD.” said Junjie Zhang, MD, Ph.D., Nanjing First Hospital, Nanjing Medical University, China.

Angiography guidance procedures

The results from our study show that compare to angiography guidance procedures; so IVUS-guide DES implantation is a new and effective treatment approach. This procedure has the potential to significantly decrease target vessel failure in CKD patients and, ultimately, improve their quality of life.

The study asses 1,443 patients of whom 723 underwent IVUS-guide DES implantations; also 720 underwent angiography-guide DES implantations from August 2014 to May 2017. The inclusion criteria were patients who had silent ischemia; so stable or unstable angina, or myocardial infarctions from the onset of chest pain to admission; so as well as de novo coronary lesions that were eligible for DES implantation.

The trial was conduct in eight hospitals throughout China and was approve at each participating center. CKD was present in 349 (24.2%) patients. CKD patients were older and more frequently present with a history of stroke, hypertension, symptomatic heart failure (HF); also lower left ventricular ejection fraction (LVEF).

The reduce risk of TVF in the IVUS group for CKD patients was mainly drive by the lower risk of Target Vessel MI (TVMI) (0.6% vs. 3.6%) and Target Vessel Revascularization (TVR) (1.1% vs. 4.7%). To further assess long-term efficacy of IVUS guide DES implantation as a treatment option, the authors of this study call for a broader randomize trial.