Management of Acute Coronary Syndromes in Patients with Renal Insufficiency

Chronic kidney disease (CKD) is highly prevalent in patients with acute coronary syndromes (ACS) and is associated with poor outcomes. The clinical management of patients with CKD who develop ACS is problematic because of the lack of well-designed randomized trials assessing therapeutic strategies in such patients. The almost uniform exclusion of patients with CKD from randomized studies evaluating new targeted therapies for ACS, and concern about further deterioration of renal function and therapy-related toxic effects, may explain the less frequent use of proven medical therapies in this subgroup of high-risk patients. This could contribute to their excessive mortality. The objective of this review is to discuss the unresolved issues and uncertainties regarding recommended medical therapies and interventional strategies in CKD patients who develop an ACS.