Onset of coronary artery disease prior to initiation of haemodialysis in patients with end-stage renal disease

Abstract

To determine whether the onset of coronary artery disease may precede the initiation of dialysis in patients with end-stage renal disease, we performed coronary angiography within 1 month of initiation of maintenance haemodialysis in 24 patients (age range 42-78 years; mean 63.7 +/- 11). Coronary angiography was performed regardless of the absence or presence of angina. Fifteen patients had diabetic nephropathy, and nine had non-diabetic nephropathy. Significant coronary stenosis was defined as at least 75% narrowing of the reference segment. Fifteen patients (62.5%) with a total of 49 lesions were classified as the coronary artery disease present group. Eleven of those 15 (73.3%) had multivessel disease. The average number of stenotic lesions was 3.3 per patient. The most common patterns of stenosis were complex (23 lesions; 47%), and diffuse lesions over 20 mm long (14 lesions; 29%). None of the clinical or haematological factors evaluated differed significantly between the groups with and without coronary artery disease. The prevalence of coronary artery disease was 72.7% in the symptomatic patients and 53.8% in the asymptomatic patients. The diagnosis of coronary artery disease at the start of maintenance haemodialysis based only on chest symptoms and clinical factors proved to be difficult. Coronary angiography is thus essential for evaluating coronary artery disease in uraemic patients. Many patients with end-stage renal disease had coronary artery disease prior to the start of haemodialysis.

Chronic Kidney Disease, Dyslipidemia, and Atherosclerosis

“…Very interestingly, the relative risk reduction was greater in the subgroup with CKD than mL/min, suggesting more rapid plaque growth in CKD stage 3 and slowed progression in later stages. These data are in agreement with the above studies using coronary angiography 48,49) , indicating that atherosclerotic changes are advanced in the pre-dialysis period of CKD.…”

“…Two studies from Japan 48,49) show that more than 50% of CKD patients starting dialysis treatment tion, and cerebral hemorrhage, the risk of death after CVD was independently predicted by higher age, higher CRP, and lower body mass index. Since total cholesterol was inversely correlated with CRP, and positively with serum albumin and body mass index in these patients, these results strongly suggest that the reverse epidemiology of cholesterol is confounded by the effects of malnutrition (protein-energy wasting) and inflammation on the risk of fatality after incident CVD.…”

Optimal Method of Coronary Revascularization in Patients Receiving Dialysis

“…More than two thirds of patients receiving dialysis have prevalent coronary artery disease, among whom three fourths are symptomatic and have multivessel disease (2). Coronary revascularization is often pursued in select patients who are sufficiently fit for the procedures or are symptomatic despite maximal medical therapy.…”

Risk of cardiovascular mortality predicted by the serum calcium level and calcification score at the initiation of dialysis

“…In addition, we identified a significant between-group difference with regard to CVD-specific CV mortality, even among patients without a history of CAD. Specifically, coronary artery stenosis, with a narrowing ≥ 75 of the normal reference segment being clinically significant [14,15], was [16]. If body fluid management becomes difficult due to the progression of uremia, heart failure develops, requiring early dialysis initiation [17].…”

“…Ethical approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (IRB Approval number: [14][15][16][17][18][19][20] and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.…”