atient-reported outcomes in people with non–dialysis-dependent CKD is needed. Background Cardiovascular disease is the leading cause of death in people with CKD. Coronary revascularization can improve cardiac function and prognosis in people with ischemic heart disease; however, in people with CKD, there is concern that potential harms could outweigh benefits of revascularization. Evidence on the balance of these risks and benefits, specifically in people with non–dialysis-dependent CKD, is lacking. Methods We conducted a systematic review of randomized controlled trials to assess the risks and benefits of revascularization, compared with medical management, among adults or children with ischemic heart disease and CKD not requiring KRT (dialysis or transplantation). We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials through December 12, 2023. Two people independently screened titles and abstracts followed by full-text review, serially extracted data using standardized forms, independently assessed risk of bias, and graded the certainty of evidence (COE). Results Evaluating data from nine randomized controlled trials, we found that people with CKD and ischemic heart disease treated with revascularization may experience lower all-cause mortality compared with people receiving medical management (risk ratio [RR], 0.80; 95% confidence interval [CI], 0.64 to 0.98; COE, low). Revascularization may reduce incidence of myocardial infarction (RR, 0.81; 95% CI, 0.64 to 1.04; COE, low) and heart failure (RR, 0.80; 95% CI, 0.52 to 1.23; COE, low). The effect on cardiovascular mortality is uncertain (hazard ratio, 0.67; 95% CI, 0.37 to 1.20; COE, very low). Evidence was insufficient for patient-reported outcomes and adverse kidney events. Data were limited by heterogeneity of patient populations and the limited number of trials. Conclusions In people with non–dialysis-dependent CKD, revascularization may be associated with lower all-cause mortality compared with medical management and may also lower the risk of cardiovascular events. Additional data surrounding kidney and patient-reported outcomes are needed to comprehensively engage in shared decision making and determine optimal treatment strategies for people with CKD and ischemic heart disease. Clinical Trial registry name and registration number: CRD42022349820 (PROSPERO)....

中文翻译：

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冠状动脉血运重建在非透析依赖性慢性肾病和缺血性心脏病中的益处和伤害：系统评价和荟萃分析


需要 ATIENT 报告非透析依赖性 CKD 患者的结局。背景 心血管疾病是 CKD 患者死亡的主要原因。冠状动脉血运重建可以改善缺血性心脏病患者的心脏功能和预后;然而，在 CKD 患者中，人们担心血运重建的潜在危害可能超过益处。缺乏关于这些风险和益处平衡的证据，特别是在非透析依赖型 CKD 患者中。方法 我们对随机对照试验进行了系统评价，以评估血运重建与药物治疗相比，在不需要 KRT （透析或移植） 的缺血性心脏病和 CKD 成人或儿童中的风险和益处。我们检索了截至 2023 年 12 月 12 日的 PubMed、Embase 和 Cochrane 对照试验中心注册库。两人独立筛选标题和摘要，然后进行全文综述，使用标准化表格连续提取数据，独立评估偏倚风险，并对证据质量 （COE） 进行分级。结果 评估了 9 项随机对照试验的数据，我们发现与接受药物治疗的患者相比，接受血运重建治疗的 CKD 和缺血性心脏病患者的全因死亡率可能较低（风险比 [RR]，0.80;95% 置信区间 [CI]，0.64 至 0.98;COE，低）。血运重建可降低心肌梗死的发生率（RR，0.81;95% CI，0.64 至 1.04;COE，低）和心力衰竭 （RR，0.80;95% CI，0.52 至 1.23;COE，低）。对心血管死亡率的影响尚不确定（风险比，0.67;95% CI，0.37 至 1.20;COE，非常低）。患者报告的结局和不良肾脏事件的证据不足。 数据受到患者群体异质性和试验数量有限的限制。结论 在非透析依赖性 CKD 患者中，与药物治疗相比，血运重建可能与较低的全因死亡率相关，也可能降低心血管事件的风险。需要围绕肾脏和患者报告结局的更多数据，以全面参与共同决策并确定 CKD 和缺血性心脏病患者的最佳治疗策略。临床试验注册名称和注册号：CRD42022349820 （PROSPERO）....