Лечение ишемической болезни сердца у пациентов с терминальной почечной недостаточностью на заместительной почечной терапии

Данная обзорная работа нацелена на анализ проблемы диагностики и лечения ишемической болезни сердца (ИБС) у пациентов с терминальной почечной недостаточностью (ТПН) на основании современных литературных данных. Рассматриваются вопросы стратификации риска ИБС перед включением пациентов в лист ожидания на трансплантацию почки и возможные сложности диагностики ИБС с помощью неинвазивных методов обследования у пациентов с ТПН. Проводится сравнение эффективности реваскуляризации миокарда и медикаментозной терапии, эндоваскулярной и хирургической реваскуляризации миокарда, а также рассматриваются особенности медикаментозной, в частности антиагрегантной и антигиперлипидемической, терапии в рамках лечения ИБС у диализ-зависимых пациентов и реципиентов почки.

1. Thompson S, James M, Wiebe N, Hemmelgarn B, Manns B, Klarenbach S et al. Cause of Death in Patients with Reduced Kidney Function. J Am Soc Nephrol. 2015; 26 (10): 2504–2511. doi: 10.1681/ASN.2014070714.

2. Sarnak MJ, Amann K, Bangalore S, Cavalcante JL, Charytan DM, Craig JC et al. Chronic Kidney Disease and Coronary Artery Disease: JACC State-of-the-Art Review. J Am Coll Cardiol. 2019; 74 (14): 1823–1838. doi: 10.1016/j.jacc.2019.08.1017.

3. ERA Registry Annual Report 2021 | EKPF. Accessed September 11, 2023. https://ekpf.eu/era-registry-annualreport-2021/.

4. Hariharan S, Israni AK, Danovitch G. Long-Term Survival after Kidney Transplantation. N Engl J Med. 2021; 385 (8): 729–743. doi: 10.1056/NEJMra2014530.

5. Мартынов СА, Северина АС, Ларина ИИ, Шамхалова МШ, Арзуманов СВ, Пинчук АВ, Шестакова МВ. Подготовка пациента с сахарным диабетом 1-го типа на заместительной почечной терапии диализом к трансплантации почки. Проблемы эндокринологии. 2020; 66 (6): 18–30. https://doi.org/10.14341/probl12686.

6. Ewing EC, Edwards AR. Cardiovascular Disease Assessment Prior to Kidney Transplantation. Methodist Debakey Cardiovasc J. 2022; 18 (4): 50–61. doi: 10.14797/mdcvj.1117.

7. Chadban SJ, Ahn C, Axelrod DA, Foster BJ, Kasiske BL, Kher V et al. KDIGO Clinical Practice Guideline on the Evaluation and Management of Candidates for Kidney Transplantation. Transplantation. 2020; 104 (4S1 Suppl 1): S11–S103. doi: 10.1097/TP.0000000000003136.

8. Karthikeyan V, Ananthasubramaniam K. Coronary Risk Assessment and Management Options in Chronic Kidney Disease Patients Prior to Kidney Transplantation. Current Cardiology Reviews. 2009; 5 (3): 177. doi: 10.2174/157340309788970342.

9. Hakeem A, Bhatti S, Chang SM. Screening and risk stratification of coronary artery disease in end-stage renal disease. JACC Cardiovasc Imaging. 2014; 7 (7): 715–728. doi: 10.1016/j.jcmg.2013.12.015.

10. Nimmo A, Forsyth JL, Oniscu GC, Robb M, Watson C, Fotheringham J et al. A propensity score-matched analysis indicates screening for asymptomatic coronary artery disease does not predict cardiac events in kidney transplant recipients. Kidney Int. 2021; 99 (2): 431–442. doi: 10.1016/j.kint.2020.10.019.

11. Genovesi S, Boriani G, Covic A, Vernooij RWM, Combe C, Burlacu A et al. Sudden cardiac death in dialysis patients: different causes and management strategies. Nephrol Dial Transplant. 2021; 36 (3): 396–405. doi: 10.1093/ndt/gfz182.

12. Vadalà G, Alaimo C, Buccheri G, Di Fazio L, Di Caccamo L, Sucato V et al. Screening and Management of Coronary Artery Disease in Kidney Transplant Candidates. Diagnostics (Basel). 2023; 13 (16): 2709. doi: 10.3390/diagnostics13162709.

13. European Renal Best Practice Transplantation Guideline Development Group. ERBP Guideline on the Management and Evaluation of the Kidney Donor and Recipient. Nephrol Dial Transplant. 2013; 28 Suppl 2: ii1–71. doi: 10.1093/ndt/gft218.

14. Lentine KL, Costa SP, Weir MR, Robb JF, Fleisher LA, Kasiske BL et al. Cardiac disease evaluation and management among kidney and liver transplantation candidates: a scientific statement from the American Heart Association and the American College of Cardiology Foundation: endorsed by the American Society of Transplant Surgeons, American Society of Transplantation, and National Kidney Foundation. Circulation. 2012; 126 (5): 617–663. doi: 10.1161/CIR.0b013e31823eb07a.

15. Cheng XS, VanWagner LB, Costa SP, Axelrod DA, Bangalore S, Norman SP et al. Emerging Evidence on Coronary Heart Disease Screening in Kidney and Liver Transplantation Candidates: A Scientific Statement From the American Heart Association: Endorsed by the American Society of Transplantation. Circulation. 2022; 146 (21): e299–e324. doi: 10.1161/CIR.0000000000001104.

16. Halvorsen S, Mehilli J, Cassese S, Hall TS, Abdelhamid M, Barbato E et al. 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery. Eur Heart J. 2022; 43 (39): 3826–3924. doi: 10.1093/eurheartj/ehac270.

17. Jegatheesan D, Yang W, Krishnasamy R, Hawley CM, Johnson DW. Cardiovascular Disease in Dialysis Patients. Aspects in Dialysis. Published online 2017.

18. Siddiqui MU, Junarta J, Marhefka GD. Coronary Revascularization Versus Optimal Medical Therapy in Renal Transplant Candidates With Coronary Artery Disease: A Systematic Review and Meta-Analysis. J Am Heart Assoc. 2022; 11 (4): e023548. doi: 10.1161/JAHA.121.023548.

19. Kamran H, Kupferstein E, Sharma N, Singh G, Sowers JR, Whaley-Connell A et al. Revascularization versus Medical Management of Coronary Artery Disease in Prerenal Transplant Patients: A Meta-Analysis. Cardiorenal Med. 2018; 8 (3): 192–198. doi: 10.1159/000487763.

20. Liao GZ, Li YM, Bai L, Ye YY, Peng Y. Revascularization vs. Conservative Medical Treatment in Patients With Chronic Kidney Disease and Coronary Artery Disease: A Meta-Analysis. Front Cardiovasc Med. 2021; 8: 818958. doi: 10.3389/fcvm.2021.818958.

21. Zheng L, Wang X, Zhong YC. Comparison of revascularization with conservative medical treatment in maintenance dialysis patient with coronary artery disease: a systemic review and meta-analysis. Front Cardiovasc Med. 2023; 10: 1143895. doi: 10.3389/fcvm.2023.1143895.

22. Yong J, Tian J, Zhao X, Yang X, Xing H, He Y, Song X. Optimal treatment strategies for coronary artery disease in patients with advanced kidney disease: a meta-analysis. Ther Adv Chronic Dis. 2021; 12: 20406223211024367. doi: 10.1177/20406223211024367.

23. Wang Z, Gong Y, Fan F, Yang F, Qiu L, Hong T, Huo Y. Coronary artery bypass grafting vs. drug-eluting stent implantation in patients with end-stage renal disease requiring dialysis. Ren Fail. 2020; 42 (1): 107–112. doi: 10.1080/0886022X.2019.1710187.

24. Taliercio JJ, Nakhoul G, Mehdi A, Yang W, Sha D, Schold JD et al. Aspirin for Primary and Secondary Prevention of Mortality, Cardiovascular Disease, and Kidney Failure in the Chronic Renal Insufficiency Cohort (CRIC) Study. Kidney Med. 2022; 4 (11): 100547. doi: 10.1016/j.xkme.2022.100547.

25. Chen ZW, Wu CK, Yang YH, Huang JW, Wu VC, Lee JK et al. Efficacy of Antiplatelet Agent Usage for Primary and Secondary Prevention in Dialysis Patients: a Nationwide Data Survey and Propensity Analysis. Cardiovasc Drugs Ther. 2019; 33 (4): 471–479. doi: 10.1007/s10557-019-06882-0.

26. Summaria F, Giannico MB, Talarico GP, Patrizi R. Antiplatelet Therapy in Hemodialysis Patients Undergoing Percutaneous Coronary Interventions. Nephrourol Mon. 2015; 7 (4): e28099. doi: 10.5812/numonthly.28099.

27. Park S, Choi YJ, Kang JE, Kim MG, Jung Geum M, Kim SD, Rhie SJ. P2Y12 Antiplatelet Choice for Patients with Chronic Kidney Disease and Acute Coronary Syndrome: A Systematic Review and Meta-Analysis. J Pers Med. 2021; 11 (3): 222. doi: 10.3390/jpm11030222.

28. Becker RC, Helmy T. Are at least 12 months of dual antiplatelet therapy needed for all patients with drug-eluting stents? Not all patients with drug-eluting stents need at least 12 months of dual antiplatelet therapy. Circulation. 2015; 131 (22): 2010–2019; discussion 2019. doi: 10.1161/CIRCULATIONAHA.114.013281.

29. Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. European Heart Journal. 2020; 41 (3): 407–477. doi: 10.1093/eurheartj/ehz425.

30. Mavrakanas TA, Chatzizisis YS, Gariani K, Kereiakes DJ, Gargiulo G, Helft G et al. Duration of Dual Antiplatelet Therapy in Patients with CKD and Drug-Eluting Stents: A Meta-Analysis. Clin J Am Soc Nephrol. 2019; 14 (6): 810–822. doi: 10.2215/CJN.12901018.

31. Chen YT, Chen HT, Hsu CY, Chao PW, Kuo SC, Ou SM, Shih CJ. Dual Antiplatelet Therapy and Clinical Outcomes after Coronary Drug-Eluting Stent Implantation in Patients on Hemodialysis. Clin J Am Soc Nephrol. 2017; 12 (2): 262–271. doi: 10.2215/CJN.04430416.

32. Park S, Kim Y, Jo HA, Lee S, Kim MS, Yang BR et al. Clinical outcomes of prolonged dual antiplatelet therapy after coronary drug-eluting stent implantation in dialysis patients. Clin Kidney J. 2020; 13 (5): 803–812. doi: 10.1093/ckj/sfaa037.

33. Giustino G,ChieffoA, Palmerini T, Valgimigli M, Feres F, Abizaid A et al. Efficacy and Safety of Dual Antiplatelet Therapy After Complex PCI. J Am Coll Cardiol. 2016; 68 (17): 1851–1864. doi: 10.1016/j.jacc.2016.07.760.

34. Carrero JJ, Varenhorst C, Jensevik K, Szummer K, Lagerqvist B, Evans M et al. Long-term versus short-term dual antiplatelet therapy was similarly associated with a lower risk of death, stroke, or infarction in patients with acute coronary syndrome regardless of underlying kidney disease. Kidney Int. 2017; 91 (1): 216–226. doi: 10.1016/j.kint.2016.09.014.

35. Palmer SC, Craig JC, Navaneethan SD, Tonelli M, Pellegrini F, Strippoli GFM. Benefits and harms of statin therapy for persons with chronic kidney disease: a systematic review and meta-analysis. Ann Intern Med. 2012; 157 (4): 263–275. doi: 10.7326/0003-4819-157-4201208210-00007.

36. Драпкина ОМ, Корнеева ОН. Статины при хронической болезни почек. Существует ли препарат выбора? Кардиоваскулярная терапия и профилактика. 2015; 14 (6): 76–80.

37. Wanner C, Tonelli M. Kidney Disease: Improving Global Outcomes Lipid Guideline Development Work Group Members. KDIGO Clinical Practice Guideline for Lipid Management in CKD: summary of recommendation statements and clinical approach to the patient. Kidney Int. 2014; 85 (6): 1303–1309. doi: 10.1038/ki.2014.31.

38. K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. American journal of kidney diseases: the official journal of the National Kidney Foundation. 2005; 45 (4 Suppl 3). doi: 10.1053/j.ajkd.2005.01.019.

39. Authors/Task Force Members, ESC Committee for Practice Guidelines (CPG), ESC National Cardiac Societies. 2019 ESC/EAS guidelines for the management of dyslipidaemias: Lipid modification to reduce cardiovascular risk. Atherosclerosis. 2019; 290: 140–205. doi: 10.1016/j.atherosclerosis.2019.08.014.

40. Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019; 139 (25): e1082–e1143. doi: 10.1161/CIR.0000000000000625.

41. Подкаменный ВА, Желтовский ЮВ, Шаравин АА, Козина ОА, Вырупаев АВ. Минимально инвазивное коронарное шунтирование у больного после трансплантации почки. Нефрология и диализ. 2019; 21 (3): 378–381. doi: 10.28996/2618-9801-2019-3-378-381.

42. Kahn MR, Fallahi A, Kim MC, Esquitin R, Robbins MJ. Coronary artery disease in a large renal transplant population: implications for management. Am J Transplant. 2011; 11 (12): 2665–2674. doi: 10.1111/j.16006143.2011.03734.x.

43. El-Qushayri AE, Reda A. Surgical versus interventional coronary revascularization in kidney transplant recipients: a systematic review and meta-analysis. Int Urol Nephrol. Published online March 12, 2023. doi: 10.1007/s11255-023-03546-9.

44. Lang J, Buettner S, Weiler H, Papadopoulos N, Geiger H, Hauser I et al. Comparison of interventional and surgical myocardial revascularization in kidney transplant recipients – A single-centre retrospective analysis. IJC Heart & Vasculature. 2018; 21: 96–102. doi: 10.1016/j.ijcha.2018.10.010.

45. Рядовой ИГ, Миронков АБ, Миронков БЛ, Бабаян ГР, Гонтуар МГ, Честухин ВВ. Проблемы эндоваскулярной реваскуляризации миокарда у реципиентов почечного трансплантата. Международный журнал интервенционной кардиоангиологии. 2011; (27–28): 35–39.

46. Kasiske BL, Zeier MG, Chapman JR, Craig JC, Ekberg H, Garvey CA et al. KDIGO clinical practice guideline for the care of kidney transplant recipients: a summary. Kidney Int. 2010; 77 (4): 299–311. doi: 10.1038/ki.2009.377.

47. Holdaas H, Fellström B, Jardine AG, Holme I, Nyberg G, Fauchald P et al. Effect of fluvastatin on cardiac outcomes in renal transplant recipients: a multicentre, randomised, placebo-controlled trial. Lancet. 2003; 361 (9374): 2024–2031. doi: 10.1016/S01406736(03)13638-0.

48. Holdaas H, Fellström B, Jardine AG, Nyberg G, Grönhagen-Riska C, Madsen S et al. Beneficial effect of early initiation of lipid-lowering therapy following renal transplantation. Nephrol Dial Transplant. 2005; 20 (5): 974–980. doi: 10.1093/ndt/gfh735.

49. Chmielnicka K, Heleniak Z, Dębska-Ślizień A. Dyslipidemia in Renal Transplant Recipients. Transplantology. 2022; 3 (2): 188–199. doi: 10.3390/transplantology3020020.

50. Akman B, Uyar M, Afsar B, Sezer S, Ozdemir FN, Haberal M. Lipid profile during azathioprine or mycophenolate mofetil combinations with cyclosporine and steroids. Transplant Proc. 2007; 39 (1): 135–137. doi: 10.1016/j.transproceed.2006.10.210.

51. Baigent C, Landray MJ, Reith C, Emberson J, Wheeler DC, Tomson C et al. The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (Study of Heart and Renal Protection): a randomised placebo-controlled trial. Lancet. 2011; 377 (9784): 2181–2192. doi: 10.1016/S01406736(11)60739-3.

52. Dad T, Tighiouart H, Joseph A, Bostom A, Carpenter M, Hunsicker L et al. Aspirin Use and Incident Cardiovascular Disease, Kidney Failure, and Death in Stable Kidney Transplant Recipients: A Post Hoc Analysis of the Folic Acid for Vascular Outcome Reduction in Transplantation (FAVORIT) Trial. Am J Kidney Dis. 2016; 68 (2): 277–286. doi: 10.1053/j.ajkd.2016.01.019.