Chronic kidney disease and heart disease: medicines-first did as well over 8 years

If you live with chronic kidney disease and stable heart disease, here is something useful. Starting treatment with medicines alone worked as well for survival as starting with an invasive procedure, even after 8 years.

In a study of 777 adults with advanced chronic kidney disease and heart disease, people who began with medicines had about the same survival over a median of 8 years as people who began with a procedure to look at and open the heart’s arteries. That gives patients and doctors more room to choose the path that fits the person.

How the study worked

This was a randomized trial, the kind where a coin-flip-style draw decides who gets which approach. It followed 777 people with advanced chronic kidney disease and heart disease that reduced blood flow to the heart. About half (388) were assigned to an invasive approach and about half (389) to a medicine-first approach. The invasive group had a dye test of the heart’s arteries and a procedure to restore blood flow when doctors could do it, plus medicines. The medicine-first group got medicines alone, and had procedures only if the medicines stopped working. Researchers checked on survival for a median of 8 years, and they located 95% of the survivors. The results appeared in Circulation on November 7, 2026. This follow-up looked at survival, so it can’t speak to how people felt day to day.

What they found

Over 8 years, the two groups ended up in nearly the same place. Deaths from any cause reached 57.4% in the invasive group and 56.8% in the medicine-first group. Deaths from heart and blood vessel causes were 40.3% and 38.4%. In plain words, the gaps were small, and the study found no real difference between the two approaches.

The researchers also measured average survival time over the follow-up: 1941 days for the invasive group and 1990 days for the medicine-first group. Those figures are close, and the statistical range around the difference was wide enough to include no difference at all.

The bottom line from the authors: for people with at least moderate reduced blood flow to the heart and advanced chronic kidney disease, starting with a procedure gave no significant long-term survival benefit over starting with medicines.

What does “initial conservative strategy” mean?

It does not mean doing nothing. It means starting with guideline-recommended medicines and keeping procedures in reserve if those medicines stop doing the job. So the medicine-first path is a full treatment plan, not a wait-and-see approach.

What you can do today

Write down two or three questions for your next kidney or heart visit, such as “Is a medicine-first plan right for me?” and “What would make us switch to a procedure later?” Bring the list and take notes. That puts you in the conversation about your own care.

Got a question? Ask us ›