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Predictors of coronary disease in patients with end stage renal disease
K Varghese1, G Cherian, U T Abraham
1Department of Cardiology, Chest Diseases Hospital, Safat, Kuwait.
Insights
For patients with end-stage renal disease awaiting kidney transplants, increasing age and a family history of early heart disease predict significant coronary artery disease (CAD). Certain non-invasive markers also proved useful in identifying CAD risk.
Area of Science:
- Nephrology
- Cardiology
- Internal Medicine
Background:
- End-stage renal disease (ESRD) patients exhibit a high prevalence of cardiovascular disease (CVD).
- Coronary arteriography is frequently performed before kidney transplantation.
- The utility of traditional risk factors and non-invasive markers for identifying coronary artery disease (CAD) in ESRD patients needs further investigation.
Purpose of the Study:
- To evaluate the effectiveness of conventional risk factors and non-invasive markers in predicting significant coronary artery disease (CAD) in patients with end-stage renal disease (ESRD).
- To determine which factors best identify patients requiring coronary arteriography prior to kidney transplantation.
Main Methods:
- A cohort of 116 patients with ESRD underwent coronary arteriography.
- Coronary artery disease (CAD) was defined as significant lesions causing >= 50% luminal diameter stenosis.
- Patient data included age, family history, symptoms (angina), ECG findings (abnormal Q waves, ST segment depression), coronary calcification, and traditional risk factors (diabetes, obesity, hypertension, hypercholesterolemia, smoking).
Main Results:
- Significant CAD was identified in 69 patients (60%).
- Predictive factors for significant CAD included increasing age, family history of premature ischemic heart disease, angina, abnormal Q waves on ECG, ST segment depression on ECG, and coronary calcification.
- Male gender, diabetes mellitus, and obesity did not correlate with CAD. Hypertension, hypercholesterolemia, and smoking were not useful predictors, potentially due to modification by renal failure.
Conclusions:
- Increasing age, a family history of premature ischemic heart disease, and specific non-invasive markers are valuable predictors of significant coronary artery disease (CAD) in ESRD patients.
- These findings can aid in triaging ESRD patients for coronary arteriography before kidney transplantation.
- Further research may explore the impact of renal failure on traditional cardiovascular risk factors.
Abstract:
Patients with end stage renal disease have a high prevalence of cardiovascular disease and coronary arteriography is often routinely performed prior to kidney transplantation. However, the value of the conventional risk factors and non-invasive markers of coronary artery disease (CAD) in triaging patients for coronary arteriography has not been fully examined. 116 patients with end stage renal disease were evaluated. Coronary arteriography was performed in all patients either for a suspicion of CAD or as part of a routine pre-transplant evaluation. Lesions causing > or = 50% luminal diameter stenosis in any of the three major coronary artery systems were considered significant. The mean age was 53.3 +/- 9.3 years. Significant CAD was present in 69 patients (60%). Increasing age, family history of premature ischemic heart disease, the presence of angina, abnormal Q waves on the ECG or abnormal ST segment depression and the presence of coronary calcification were significant markers of coronary artery disease. However male gender, diabetes mellitus and obesity did not correlate with coronary disease. Even though hypertension, hypercholesterolemia and smoking were also not useful predictors these could have been modified by the renal failure. In conclusion increasing age, a family history of premature ischemic heart disease and some non-invasive markers were useful predictors of coronary disease.