Comparative Outcomes of Drug-Eluting Stents Versus Drug-Eluting Balloons in Patients with Chronic Kidney Disease: A Systematic Review of Current Evidence.

Abstract

<h4>Background</h4>Chronic kidney disease (CKD) is a significant comorbidity in cardiovascular treatments, increasing the likelihood of adverse outcomes. Choosing between drug-eluting balloons (DEB) and drug-eluting stents (DES) in patients with CKD requires careful consideration of efficacy and safety. To address this gap, we conducted a systematic review of DEB and DES in CKD patients, focusing on mortality, MACE, TLR, and stent thrombosis.<h4>Methods</h4>This systematic review followed the PRISMA guidelines. Comprehensive searches were performed in PubMed, Cochrane Library, Scopus, Web of Science, and ScienceDirect until September 2025. Randomized controlled trials (RCTs) and cohort study comparing DEB and DES in CKD patients were included. Four reviewers independently screened and extracted data on mortality, MACE, target lesion revascularization (TLR), and stent thrombosis, and conflicts were resolved through discussion.<h4>Results</h4>Five studies (four retrospective cohorts, one RCT) met inclusion criteria after screening 4,093 records, involving CKD/ESRD patients undergoing PCI with DEB (paclitaxel-coated) versus contemporary DES. MACE rates were equivalent: 17% in both arms (Funayama et al., ESRD dialysis cohort) and 10% in both arms (Jeger et al., RCT; HR 0.99, 95% CI 0.38-2.57). Target lesion revascularization (TLR) and target vessel failure (TVF) showed heterogeneity: DES favored in some (e.g., Waha et al., aHR 0.20, 95% CI 0.06-0.69), DEB numerically in others (e.g., Joh et al., 2-year TVF 14.3% DEB vs. 27.8% DES), with no meta-analysis due to clinical/methodological differences; thrombosis was low and sparse (0% DEB vs. 2.2% DES in Funayama).<h4>Conclusion</h4>In CKD/ESRD patients, DEB and DES yield equivalent MACE, though TLR/TVF results vary by study design, CKD severity, and procedural factors. No clear superiority emerged, supporting individualized strategy selection based on lesion characteristics, bleeding risk, and expertise. Prospective RCTs with standardized CKD subgroups and DEB optimization are needed for definitive guidance.PROSPERO registration ID: CRD420251039001 (05/15/2025).