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          For more information on the main ISCHEMIA Trial, please visit the ISCHEMIA Website

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What is the ISCHEMIA-CKD study?

  • The International Study of Comparative Health Effectiveness with Medical and Invasive Approaches—Chronic Kidney Disease trial (ISCHEMIA-CKD) is an international comparative effectiveness study to determine the best way to manage stable ischemic heart disease in patients with advanced chronic kidney disease (eGFR <30 or on dialysis).
  • Patients with advanced CKD and ischemia on stress test may be eligible for participation
  • The trial is designed to run seamlessly in parallel to the main ISCHEMIA trial

If you would like to hear more about the trial, please watch this brief video summary from the ISCHEMIA-CKD Principal Investigator.

Why is the ISCHEMIA-CKD study important?

More than 500 million adults worldwide have chronic kidney disease and this number is projected to rise with increasing prevalence of diabetes, obesity and the elderly. Among patients with CKD, cardiovascular disease is the leading cause of death, 15-30 times higher than the age-adjusted cardiovascular mortality rate in the general population and is worse than that for patients in the general population who have cancers, heart failure, stroke or heart attack. Participants with CKD are 5-10 times more likely to die than to reach end stage renal disease (ESRD) requiring dialysis.  Despite this, ~80% of contemporary coronary artery disease trials exclude CKD participants.  Most of the treatments aimed at reducing their cardiovascular events are therefore extrapolated from cohorts without CKD. Consequently, the optimal management approach to these patients is unknown.

This trial will inform clinicians and patients about a common question they encounter: when a patient with advanced chronic kidney disease has a abnormal cardiac stress test: is it better to do an invasive angiogram (take a picture of the heart arteries) with the intention of opening or bypassing any blockages with stents or surgery plus optimal medical therapy, or is it better to optimize medical therapy and only consider the angiogram with stents or surgery if symptoms cannot be controlled? If there is a benefit to doing an angiogram and treating with stents or surgery, then clinicians and patients must be made aware of these benefits and put them into practice to prevent bad outcomes like heart attacks and death; if the results show there is no benefit or there is harm from that routine invasive testing, then treatment would begin with only intensive lifestyle change and medication to control symptoms and reduce risk. Either finding could provide much-needed information to guide practice and improve quality of medical care.

If you are a physician and would like more information, please visit the For Physicians section. If you are a patient and would like to learn more about the ISCHEMIA-CKD study, please e-mail ischemia@nyumc.org