Chronic Kidney Disease Cardiovascular morbidity and mortality rates are markedly increased in patients with chronic kidney disease (CKD) when compared with age-matched controls without CKD. The mortality rate for patients on hemodialysis is 20% per year, and approximately 50% of deaths among these patients are due to a cardiovascular cause.476,477 To date, randomized comparisons of coronary revascular- ization (with CABG or PCI) and medical therapy in patients with CKD have not been reported. Some, but not all, observational studies or subgroup analyses have demon- strated an improved survival rate with revascularization compared with medical therapy in patients with CKD and multivessel CAD,478 480 despite the fact that the incidence of periprocedural complications (eg, death, MI, stroke, infec- tion, renal failure) is increased in patients with CKD com- pared with those without renal dysfunction. Some studies have shown that CABG is associated with a greater survival benefit than PCI among patients with severe renal 3.9.3. Completeness of Revascularization Most patients undergoing CABG receive complete or nearly complete revascularization, which seems to influence long- term prognosis positively.486 In contrast, complete revascu- larization is accomplished less often in subjects receiving PCI (eg, in 70% of patients), but the extent to which the absence of complete initial revascularization influences outcome is less clear. Rates of late survival and survival free of MI appear to be similar in patients with and without complete revascularization after PCI. Nevertheless, the need for subse- quent CABG is usually higher in those whose initial revas- cularization procedure was incomplete (compared with those with complete revascularization) after PCI.487 489 3.9.4. 