Treatment of Acute Coronary Syndromes in Patients Who Have Chronic Kidney Disease Rory O’Hanlon, MB, BMedSci, MRCPI a , Donal N. Reddan, MB, MHS, MRCPI b,c, * a Division of Cardiology, University College Galway Hospital, Galway, Ireland b Division of Nephrology, University College Galway Hospital, Unit 1, Merlin Park Hospital, Galway, Ireland c Division of Nephrology, Department of Medicine, Duke University, Durham, NC, USA Chronic kidney disease (CKD) is an important risk factor for cardiovascular morbidity and mortality [1], yet evidence regarding treatment of ischemic heart disease among CKD patients remains limited. Mild CKD defined as a glomerular filtration rate (GFR) less than 60 mL/min/1.73m 2 is nearly 10 times more prevalent than end-stage renal disease (ESRD). The National Health And Nutrition Epidemiology Survey estimates that renal disease affects at least 3 million people in the United States alone [2], and although the impact of dialysis-dependent renal failure on cardiovascular diseases has been studied to some extent, milder forms of CKD may not yet have been sufficiently investigated. Analyses of the associations of CKD are difficult to compare because of unclear definitions of what constitutes CKD and how to measure it exactly. Often in the cardiovascular literature a serum creatinine less than 1.5 mg/dL has been used to identify ‘‘normal renal function’’ and a creatinine greater than or equal to 1.5 mg/dL has been used to identify CKD. The consistent use of GFR measured either directly or indirectly using approximation formulae, as opposed to serum creatinine, increases the accurate identification of patients with abnormal renal function and identifies a greater number of patients with CKD. The approximation formula currently recommended by the National Kidney * Corresponding author. Division of Nephrology, University College Galway Hospital, Unit 1, Merlin Park Hospital, Galway, Ireland. E-mail address: donal.reddan@whb.ie (D.N. Reddan). 0025-7125/05/$ - see front matter Ó 2005 Elsevier Inc. All rights reserved. doi:10.1016/j.mcna.2004.11.008 medical.theclinics.com Med Clin N Am 89 (2005) 563–585