Difficulties in treatment of acute coronary syndrome in a patient with end-stage chronic renal failure on program hemodialysis (case description)

Abstract

Background. The surgical treatment of the coronary heart disease (acute coronary syndrome) in patients undergoing program hemodialysis has its own characteristics, which are not fully reflected in the cardiological recommendations. In particular, coronary artery bypass grafting is preferable to stenting, the drug of choice among p2y12 platelet receptor blockers is clopidogrel, with the infeasibility of rosuvastatin prescription. All these points are often ignored by treating doctors from the cardiology team when choosing the optimal treatment strategy for patients in this group. Description of the clinical case. The article presents a case of treating acute coronary syndrome in a patient undergoing program hemodialysis. The problems of coronary revascularization and the drug therapy in this category of patients are discussed, and the ways to solve them are shown by the example of this clinical case. Conclusion. In special cases, such as acute coronary syndrome in patients with chronic renal failure who are on program hemodialysis, the endovascular treatment strategy should be considered only if the specifics of the prescribed pharmacotherapy are taken into account.

Keywords

• acute coronary syndrome
• hemodialysis
• end-stage renal disease