Problems of Diagnosis and Treatment of Acute Coronary Syndrome in Patients With Chronic Kidney Disease

Highlights In the modern literature, the algorithms for managing patients with CKD and ACS are not fully covered. However, approximately one in three ACS patients has CKD. To date, the frequency of using radial arterial access and intravascular imaging in patients with ACS and CKD in clinical practice is increasing, which significantly improves outcomes. However, many topics related to these issues remain poorly understood, so it is necessary to conduct specialized studies among all stages of CKD, taking into account eGFR, and the severity of albuminuria. Abstract The number of patients suffering from chronic kidney disease (CKD) is growing progressively, in half of the cases they die from cardiovascular diseases (CVD) before they reach the terminal stage of renal failure. Patients with CKD belong to a special group of the population when considering ACS therapy. CKD complicates diagnosis, risk stratification, pharmacological therapy, invasive treatment, and ACS outcomes. The purpose of the review is to analyze the domestic and foreign literature on the management of ACS in patients with CKD, as well as to offer practical recommendations for practitioners and identify current knowledge gaps that require further research. ACS makes a significant contribution to the morbidity and mortality of patients with CKD, which makes it extremely relevant to study the features of ACS management in this group of patients. It is not uncommon for patients and clinicians to reject scientifically based diagnostic and therapeutic methods due to concerns about worsening renal failure. Although overcoming this phenomenon partly depends on following the recommendations, a complete solution to the problem will equally depend on a proper assessment of the risks, pharmacological and invasive factors characteristic of patients with CKD. To date, the frequency of using radial arterial access and intravascular imaging in patients with ACS and CKD in clinical practice is increasing, which significantly improves outcomes. Nevertheless, a large number of knowledge gaps remain, so it is necessary to conduct specialized studies among all stages of CKD, not only taking into account eGFR, but also the severity of albuminuria. It is important to note that this will require better representation of CKD patients in randomized trials.