Early-invasive strategies for the management of coronary heart disease in chronic kidney disease: is acute kidney injury a consideration?

Purpose of review People with chronic kidney disease (CKD) are less likely to receive early-invasive management of acute coronary syndrome (ACS). The purpose of this article is to review the risks and outcomes of early-invasive versus conservative strategies, and to consider how contrast-induced acute kidney injury (CI-AKI) should factor in treatment decisions for people with CKD. Recent findings Numerous observational studies have characterized the prognostic importance of CI-AKI. However, recent studies illustrate that compared to the risk of AKI in individuals treated conservatively, the additional risk of kidney injury associated with invasive coronary procedures is relatively modest. Despite the risk of CI-AKI, early-invasive management of ACS has been associated with important long-term benefits. These findings illustrate that the additional short-term risk of AKI associated with invasive management should be considered alongside long-term treatment effects on other clinical outcomes and should not act as a deterrent to their use. Strategies to increase the uptake of an invasive management approach, accompanied by the use of CI-AKI prevention strategies, could benefit high-risk individuals with CKD.