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which is the most frequent underlying disorder in patients started on hemodialysis therapy, the prognosis of CAD is especially poor.2 The number of patients with diabetes mellitus has been continuously increasing and this trend is serious, not only in the field of cardiovascular medicine but in other related fields as well. o large-scale randomized studies have been conducted yet to verify the efficacy of invasive coronary revascularization (percutaneous coronary intervention [PCI] vs. coronary artery bypass grafting [CABG]) in hemodialysis (HD) patients with coronary artery disease (CAD). This may be primarily attributable to impairment of the activities of daily living (ADL) and poor general condition of HD patients seen frequently as a result of cerebro-/cardiovascular disease, dysdialysis syndrome, and/or malnutrition, as well as the mental, psychological, familial and social problems of these patients. It is unclear whether evidence from retrospective studies carried out in Europe and the United States to examine the relative superiority of coronary revascularization procedures in HD patients would be applicable to Japanese patients or not, because there are obvious differences between Western countries and Japan in the percentages of cases treated by these procedures, in the medical care systems, including the hemodialysis therapy system, the morbidity rate of CAD, etc.

What is the Appropriate Strategy for Coronary Revascularization in Hemodialysis Patient in Japan?