Stress myocardial perfusion gated-SPECT imaging in advanced chronic kidney disease

Abstract

Cardiovascular death is a leading cause of death in patients with chronic kidney disease (CKD), while the risk of cardiovascular mortality, adjusted for traditional cardiovascular risk factors and albuminuria, is linearly and negatively correlated with renal function. 1 In particular, cardiovascular mortality in CKD patients who are on dialysis is 10 to 20 times higher than in the general population. 2,3 This increased cardiovascular risk primarily concerns coronary artery disease (CAD), 4 with CKD patients exhibiting high prevalences of traditional cardiovascular risk factors (advanced age, hypertension, diabetes, dyslipidemia) as well as certain uremia-specific risk factors. 5 It should also be borne in mind that the atherosclerotic process in CKD patients can remain highly active even after renal transplantation, with hypertension, hyperlipidemia, and hyperglycemia being further facilitated by immunosuppressant therapy (corticosteroids, calcineurin inhibitors). Indeed, the mortality of CKD patients remains of cardiovascular origin in 35% to 50% of cases after transplantation. 4

Diabetic patients with chronic kidney disease: Non-invasive assessment of cardiovascular risk

“…According to studies, abnormal SPECT is a good indicator of future acute coronary events and cardiovascular disease in diabetic and non-diabetic CKD patients[ 128 ]. Conversely, a normal SPECT is associated with a fairly good cardiovascular outcome in CKD patients, but it should be noted that due to accelerated coronary atherosclerosis in patients with CKD stages 4 and 5, a normal SPECT testing is still linked to higher cardiovascular risk compared to patients with better renal function[ 129 ]. In these patients, continuous follow-up is pivotal in preventing major adverse cardiovascular events[ 130 ].…”