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[Coronary revascularization in uremic diabetic patients under chronic hemodialysis]
Insights
Coronary heart disease is a major cause of death in patients on chronic hemodialysis (CHD). Pre-transplant aortocoronary bypass surgery in high-risk diabetic CHD patients with severe coronary artery disease shows successful outcomes.
Area of Science:
- Nephrology
- Cardiology
- Transplantation
Background:
- Coronary heart disease (CHD) is the leading cause of mortality in patients undergoing chronic hemodialysis (CHD).
- Outcomes after renal transplantation are significantly impacted by pre-existing cardiovascular disease, particularly in diabetic patients.
Observation:
- This study details the experience with two diabetic patients with end-stage renal disease on CHD who underwent aortocoronary bypass surgery prior to renal transplantation.
- Both patients presented with severe coronary artery lesions requiring surgical intervention.
Findings:
- Successful outcomes were observed in both patients at 30 and 55 months post-surgery.
- Aortocoronary bypass surgery proved effective in managing severe coronary artery disease in this high-risk cohort.
Implications:
- Coronary angiography is recommended for all high-risk CHD patients, including diabetics and the elderly, before renal transplantation.
- Aortocoronary bypass surgery should be considered for CHD patients with severe coronary disease to improve post-transplant outcomes.
- The technical aspects and challenges of performing surgery on uremic patients are analyzed.
Abstract:
Coronary heart disease is the main cause of mortality among uremic patients on chronic hemodialysis (CHD) and is the determinant of the outcome in these cases after renal transplantation, especially in diabetics. In this study we report our experience with two uremic diabetics on CHD with severe coronary artery lesions in whom aortocoronary bypass was performed before renal transplantation. The outcome in the two patients, after 30 and 55 months respectively indicates successful results. We discuss the necessity to perform coronariography in all the high risk patients on CHD, such as diabetics and elderly before planning renal transplantation and achieve aortocoronary bypass surgery in those with severe coronary disease. The technics and difficulties of the surgery in uremics are also analized.