Only one study identi- fied by the writing committee used the Kidney Disease Outcome Quality Definition of renal disease grades: Stage 1, mL/min; and Stage 5, ,15 mL/min or ongoing dialysis (1186). Others studies simply described patients as receiving dialysis1187,1188 or defined renal disease as any creatinine clearance ,60 mL/min1189,1190 or any serum creatinine above approximately 2.3 mg/dL.1191,1192 Ongoing studies are begin- ning to use the AKIN (Acute Kidney Injury Network) or RIFLE (Risk, Injury, Failure, Loss, and End-stage) criteria and should ensure more consistency in the study of peripro- cedural complications of percutaneous revascularization. Among patients who were enrolled in the COURAGE trial, the presence of CKD was associated with odds of 1.48 for death, MI, or new heart failure relative to patients without kidney disease.1193 Medical therapy, however, was effective and associated with the same BP and lipid levels as in patients without CKD. Patients with CKD also experience significant and sustained improvement in angina with both PCI and GDMT, and there was no significant interaction between the presence of CKD and treatment assignment in survival rate, incidence of AMI, or improvement in symptoms. 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,1191,1193,1194 despite the fact that the inci- dence of periprocedural complications (eg, death, MI, stroke, infection, renal failure) is higher in patients with CKD than in those without renal dysfunction. 