Harvard Heart Letter

CABG vs angioplasty in kidney disease

Older people with chronic kidney disease often develop heart disease, since atherosclerosis can affect the arteries of both organs. Sometimes, a procedure to restore blood flow to the heart—either with coronary artery bypass grafting (CABG) or angioplasty and stenting—is necessary. However, both procedures carry more risk in people with kidney disease. Dr. David Charytan, a kidney specialist at Harvard-affiliated Brigham and Women's Hospital, and colleagues in Minneapolis compared the risks of death and irreversible kidney failure requiring dialysis or transplantation (called end-stage renal disease, or ESRD) with both procedures in 13,000 Medicare patients with chronic kidney disease. CABG, was associated with higher rates of death and ESRD in the months immediately after the procedure. However, in the longer term (six months to three years after the procedure), CABG was associated with the same risk of ESRD as with angioplasty, as well as a 39% lower risk of death, and a 34% lower risk of the combination of ESRD and death. The researchers concluded that CABG is generally the better option for older individuals with chronic kidney disease, but that angioplasty would be preferred when the major concerns are avoiding ESRD or dying shortly after the procedure.

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