Département de cardiologie médicale, groupe hospitalier Pitié-Salpêtrière, 47-83 bd de l’Hôpital, 75013 Paris
The prevalence of coronary artery disease is markedly increased in patients with chronic renal failure, and accounts for half of the total mortality in patients with end-stage renal disease. This accelerated atherosclerosis is related, at least in part, to the presence of numerous classical risk factors. Non invasive stress tests are used to detect silent myocardial ischemia in patients at high-risk of cardiac event, particularly in diabetics, or before renal transplantation or vascular surgery. Cardiac catheterization and coronary angiography should be restricted to patients in whom revascularization can improve prognosis, which is demonstrated in the presence of severe or diffuse myocardial ischemia. The prevention of contrast nephropathy mostly includes mostly hydration and low volume of contrast media. The choice between coronary stenting and cardiac surgery depends on the surgical risk, presence of associated valve disease, and coronary anatomy. The rate of cardiac events after revascularization remains much higher than in patients without renal failure. The improvement of prognosis in patients with coronary disease and renal failure also requires a multidimensional approach for management of left ventricular hypertrophy, heart failure, arrhythmias, and intensive treatment of risk factors such as diabetes, hypertension, anemia, hyperparathyroidism.