Chronic kidney disease (CKD) is accompanied by coronary artery disease (CAD) in most patients. In this article we describe differences in the pathogenesis, diagnosis, and treatment of CAD compared with patients without kidney impairment. The histological phenotype as well as the clinical presentation of acute and chronic coronary syndromes differ from those of patients with normal kidney function. The risk of cardiovascular events including death is strikingly increased with higher stages of CKD. Traditional but even more nontraditional cardiovascular risk factors are contributing to this increase. Screening and diagnostic procedures show limited sensitivity and specificity. Lifestyle modification is important for reducing the progression of both CKD and CAD. A special emphasis should be placed on physical exercising. Equally important is a strict antihypertensive therapy due to the very high incidences of hypertension in CKD patients. Blockade of the renin–angiotensin–system is imperative providing that adverse effects can be managed. Target blood pressure should be at 130 mm Hg systolic. Antiglycemic treatment should be implemented with metformin and SGLT2-inhibitors as first-line therapy, and glomerular filtration rate thresholds must be respected for both drugs. The risk of hypoglycemia is increased with worsening kidney function. Statins are indicated for up to stage 5 CKD. When a revascularization procedure is indicated (percutaneous intervention or bypass grafting), higher rates or peri-interventional morbidity and mortality must be anticipated. Taken together, the available literature on patients with CKD and CAD is clearly restricted compared with that on CAD patients with preserved kidney function. Mechanisms of arteriosclerosis and atheromatosis in CKD deserve more attention in the future. One major innovation in the field is SGLT2-inhibitor treatment with its concordant advantages for kidney and cardiac protection.

在大多数患者中，慢性肾脏病（CKD）伴有冠状动脉疾病（CAD）。在本文中，我们描述了与没有肾脏损害的患者相比，CAD的发病机理，诊断和治疗的差异。急性和慢性冠状动脉综合征的组织学表型和临床表现与肾功能正常的患者不同。随着CKD阶段的增加，包括死亡在内的心血管事件的风险显着增加。传统但甚至更多的非传统心血管疾病危险因素也在助长这一增长。筛选和诊断程序显示出有限的敏感性和特异性。改变生活方式对于减少CKD和CAD的进展很重要。应特别强调体育锻炼。同样重要的是，由于CKD患者高血压的发生率很高，因此严格的降压治疗也很重要。肾素-血管紧张素-系统的阻断是必须的，前提是可以控制不良反应。目标血压应为收缩压130 mm Hg。降糖治疗应以二甲双胍和SGLT2抑制剂作为一线治疗，并且两种药物均应遵守肾小球滤过率阈值。肾脏功能恶化会降低低血糖的风险。他汀类药物可用于第5级CKD。当需要进行血运重建手术（经皮介入或旁路移植）时，必须预期更高的发生率或围手术期的发病率和死亡率。在一起 与CKD和CAD患者相比，与肾功能保留的CAD患者相比，现有文献明显受到限制。CKD中动脉硬化和动脉粥样硬化的机制在未来值得更多的关注。该领域的一项重大创新是SGLT2抑制剂治疗，它在肾脏和心脏保护方面具有一致的优势。