CORONARY ARTERY INVOLVEMENT IN CHRONIC KIDNEY DISEASE PATIENTS UNDERGOING A CORONARY ANGIOGRAM:RESULTS FROM A COLLABORATIVE STUDY FROM INDIA AND BANGLADESH.

CORONARY ARTERY INVOLVEMENT IN CHRONIC KIDNEY DISEASE PATIENTS UNDERGOING A CORONARY ANGIOGRAM:RESULTS FROM A COLLABORATIVE STUDY FROM INDIA AND BANGLADESH.

Chronic kidney disease (CKD) is slowly becoming a leading cause of mortality worldwide. With the increased incidence of diabetes mellitus and hypertension both CKD and cardiovascular (CV) disease co-exist in the same patient. Over the years the increased incidence  of heart failure in advanced stages of CKD is becoming more apparent. Hypertensive heart disease is the predominant form of CV morbidity in end-stage kidney disease, whereas atherosclerotic cardiovascular disease is seen in the earlier stages of CKD. The incidence of ischemic coronary artery disease in CKD patients is not clear as majority of the patients often don't undergo coronary angiogram because  of the concern of contrast induced acute kidney injury (AKI). However in certain clinical situations of acute coronary syndrome and myocardial infarction, angiographic evaluation becomes necessary. This study tries to look at the type and extent of  coronary involvement in these patients.

A prospective cohort study involving all  adult CKD patients undergoing coronary angiogram (CAG) between 30th December 2021 to 30th September 2023 were included in the study. The study was conducted between two centres (one in Bangladesh and one in India). All patients who were advised coronary angiogram and who consented for the study were included in the study.Patients with stage I CKD and with an ongoing AKI episode were excluded. The diagnosis of ischemic heart disease was made clinically based on symptoms of angina and on investigations  (echocardiogram , cardiac enzymes and ECG). Demographic details, comorbidities and serum creatinine were studied in all patients. The coronary angiogram report was looked and data was collected for the coronary artery involvement and severity of lesions (<70%, 70-90% and >90%) was noted. The distribution of the lesions according to the stage of CKD was also noted.

The descriptive statistical analyses were done with SPSS version 24.

Left anterior descending coronary artery is the commonest artery involved in the coronary angiogram done in this CKD cohort.The incidence and severity of lesions were not statistically significant as the CKD stage advances.