Percutaneous coronary interventions in the high-risk renal patient: strategies for renal protection and vascular protection.

CKD is the most important factor in predict-ing adverse short- and long-term outcomes after PCI. Hence, the rationale for renal end-organ protection is based on chronic renal protection,avoidance of additive renal insults, and a comprehensive CIN prophylaxis. The pathogenesis of CIN goes beyond serum creatinine and involves a unique vascular pathobiology in which interrelates renal and CVD outcomes are interrelated. Attempts at PCI in patients with CKD and ESRD are high-risk procedures, but the risks involved seem to be warranted given comparative outcomes in conservatively treated patients. The benefits of short- and long-term vascular protective therapies in CKD patients have been confirmed, and these therapies are an important component of PCI care.