INTRODUCTION:
Advanced chronic kidney disease is described as stages 3-5 of the
chronic kidney disease classification defined as a reduction in
glomerular filtration rate of less than 60 ml/min (1). Chronic kidney
disease (CKD) has been known as one of the prominent risk factors for
coronary artery disease (2). Percutaneous coronary intervention (PCI)
has become an acceptable alternative to open heart surgery in patients
suffering from coronary artery disease (3). This procedure improves
patient survival, appropriately controls angina symptoms, reduces the
need for long-term hospitalization, and reduces treatment costs (4-5).
However, similar to other invasive or even minimally invasive
therapeutic interventions, this procedure should be performed in
high-risk groups with some considerations and precautions. These
patients may experience far different outcomes than low-risk patients
who have PCI. In patients with chronic kidney disorders, the need to use
contrast material, scheduling consecutive dialysis sessions, the risk of
microembolization, and requiring arterial wall instrumentation may lead
to poorer outcomes of the PCI procedure, and the clinical benefits of
PCI may be lower in such patients (6). In the last decade, various
trials have evaluated the outcomes of the procedure in patients with
CKD, which were basically associated with contradictory results. In a
large, randomized trial (ISCHEMIA-CKD) on 777 CKD patients who underwent
PCI procedure or medical therapy, 3.2-year outcomes including death,
cardiac ischemic attack, or re-hospitalization were shown to be similar
in both groups (7). In several trials, the presence of underlying
chronic kidney disease was considered a major risk factor for long-term
poorer outcomes following PCI, such as higher mortality and progression
of renal impairment (8-9), also the impaired renal elimination of
antithrombotic drugs exposes these patients to a higher likelihood of
bleeding complications (10-11). During our literature review on
databases, we found a small number of studies looking into the impacts
of PCI on ACKD patients, Limpijankit and his colleague as one of the few
studies in this matter determined one-year survival of PCI among 207 CKD
patients stage 4-5 without dialysis and 5 with dialysis was 65.2%,
68.0% and 69.4 respectively (12). Therefore, the outcome of PCI
procedures in patients with ACKD still remains uncertain. In the present
study, we investigated the clinical outcomes of PCI in cases with
Advanced chronic kidney disease and compared the in-patient mortality
rate of PCI between ACKD and non-ACKD candidates.