DOI: 10.25881/20728255_2023_18_4_134


Shengelia L.D.1, Donakanyan S.A.1, Fatulaev Z.F.1, Abramyan M.V.1, Churko A.A.2, Konshina M.O.1

1 A.N. Bakoulev Scientific Center for Cardiovascular Surgery, Moscow

2 Pavlov First Saint Petersburg State Medical University, St. Petersburg


Patients with chronic kidney disease have high risk of cardiovascular diseases, while patients with end–stage chronic kidney disease, initially on dialysis, whom myocardial revascularization is recommended, represent a separate, more severe group of patients with their own clinical and pathophysiological features. Myocardial revascularization is indicated for patients in the terminal stage of kidney disease, but the risk of death and the development of intra- and postoperative complications is higher. Despite the significant achievements of endovascular surgery, coronary artery bypass grafting is the preferred method of the surgical treatment of coronary heart disease in this category of patients, demonstrating more evidence-based long-term results. In this clinical case, the pathophysiological features of coronary heart disease in the patient with end-stage chronic kidney disease are reflected and the effectiveness of coronary artery bypass grafting in the treatment of coronary heart disease in the patient, who needs dialysis.

Keywords: chronic kidney disease, coronary artery bypass grafting, myocardial revascularization.


1. Venkatesh K., Sudarshan B., Kunal C. Ischemic Heart Disease in Patients Undergoing Dialysis, Hospital Practice. 2012; 4: 33-39. doi: 10.3810/hp.2012.10.1001.

2. Ther A. Patient Registration Committee, Japanese Society for Dialysis Therapy: An overview of regular dialysis treatment in Japan. 2004; 8: 358-382.

3. Tanaka Y, Nobuhiko J, Hiroki H. Affiliations Ischemic Heart Disease in Patients with End-Stage Kidney Disease. 2015; 40(4): 332-6. doi: 10.1159/000441582.

4. Herzog C, Asinger R, Berger A, Charytan D, Díez J, Hart R, et al. Cardiovascular disease in chronic kidney disease. A clinical update from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int. 2011; 80: 572-586.

5. Cerasola G, Nardi E, Palermo A, Mulè G, Cotone S. Epidemiology and pathophysiology of left ventricular abnormalities in chronic kidney disease: a review. 2011; 24: 1-10.

6. Chu-Lin C, Te-Chao F. Coronary artery disease in dialysis patients: What is the optimal therapy? Tzu Chi Medical Journal. 2013; 25: 82-85. doi: 10.1016/j.tcmj.2013.02.002.

7. Burton J, Jefferies H, Selby N, McIntyre C. Hemodialysis- induced repetitive myocardial injury results in global and segmental reduction in systolic cardiac function. Clin J Am Soc Nephrol. 2009; 4(12): 1925-1931.

8. Sniderman A, Solhpour A, Alam A, Williams K, Sloand J. Cardio- vascular death in dialysis patients: lessons we can learn from AURORA. Clin J Am Soc Nephrol. 2010; 5(2): 335-340.

9. Vienken J. Hemodialysis as an Experimental Therapy: Georg Haas and the First Clinical Treatment of a Human Kidney Patient. Dialysis. 2012; 43-50. doi: 10.1142/9789814289764_0007.

10. Klváček A, Šantavý P, Zuščich O, Konečný М, Hájek R, Lonský V. Pětileté zkušenosti se srdečními operacemi u pacientů závislých na dialyze. Cor et Vasa. 2015; 57(2): e86-e90. doi: 10.1016/j.crvasa.2015.03.004.

11. Sokolova NYU, Goluhova EZ. Revaskulyarizaciya miokarda u bol’nyh stabil’noj ishemicheskoj bolezn’yu serdca: stratifikaciya perioperacionnyh i otdalennyh riskov. Kreativnaya kardiologiya; 2016; 10(1): 25-36. (In Russ.) doi: 10.15275/kreatkard. 2016.01.03.

12. Melikulov AA, Merzlyakov VYU, Klyuchnikov IV, Skopin AI, Mamedova SK, ZHalilov AK, et al. Neposredstvennye rezul’taty koronarnogo shuntirovaniya na rabotayushchem serdce u pacientov vysokogo hirurgicheskogo riska. Annaly hirurgii. 2017; 22(6): 353-360. (In Russ.)

13. Chung-Dann K, Yu-Jen Y. Coronary Artery Bypass Grafting in Patients with Dialysis-Dependent Renal Failure. Tex Heart Inst J. 2004; 31: 224-30.

14. Cui K, Liu H, Yuan F, et al. Coronary artery bypass graft surgery versus stenting for patients with chronic kidney disease and complex coronary artery disease: a systematic review and meta-analysis. Therapeutic Advances in Chronic Disease. 2021; 12. doi: 10.1177/ 2040622321990273.

15. Bocharov AV, Sidorov DV, Popov LV. Difficulties in Treatment of Acute Coronary Syndrome in a Patient with End-Stage Chronic Renal Failure on Program Hemodialysis (Case Description). Journal of Clinical Practice. 2020; 11(3): 102-106. (In Russ.) doi: 10.17816/clinpract33946.

16. Soldatkina AO, Yarustovsky MB, Abramyan MV, Kudzoeva ZF, Kamardina EV, Nazarova VI. Features of perioperative management of the cardiac surgery patients with end-stage chronic kidney disease. Topical aspects of the extracorporeal blood purification in intensive care. 2018: 70-71. (In Russ.)

17. Yarustovsky MB, Abramyan MV, Soldatkina AO, Muratov RM, Bokeria OL, Kudzoeva ZF, et al. Features of perioperative management in patients with end-stage renal disease requiring surgical correction of cardiovascular pathology. Nephrology and dialysis. 2018; 20(3): 281-289. (In Russ.)

For citation

Shengelia L.D., Donakanyan S.A., Fatulaev Z.F., Abramyan M.V., Churko A.A., Konshina M.O. Ischemic heart disease in patients with end-stage chronic kidney disease: pathophysiological features and surgical treatment. Bulletin of Pirogov National Medical & Surgical Center. 2023;18(4):134-139. (In Russ.)