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Outcomes of Routine Coronary Angiography in Asymptomatic Patients With End-Stage Renal Disease Prior to Kidney
Tahir I Mohamed1,2, Omar J Baqal3, Abdulaziz A Binzaid1
1Heart Center Department, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.
Insights
Coronary artery disease (CAD) is common in asymptomatic patients with end-stage kidney disease (ESKD) undergoing hemodialysis. Further research is needed to determine optimal cardiovascular screening and revascularization strategies before kidney transplantation.
Area of Science:
- Nephrology
- Cardiology
- Vascular Medicine
Background:
- End-stage kidney disease (ESKD) significantly increases cardiovascular risk.
- Asymptomatic coronary artery disease (CAD) is prevalent in ESKD patients awaiting kidney transplantation.
Purpose of the Study:
- To determine the prevalence of CAD in asymptomatic ESKD patients on hemodialysis.
- To explore revascularization strategies for CAD in this high-risk population prior to kidney transplantation.
Main Methods:
- Retrospective single-center study of 368 ESKD patients undergoing coronary angiography (2003-2018).
- Patients were asymptomatic and did not undergo noninvasive cardiac testing prior to angiography.
- Analysis of CAD prevalence, extent, and outcomes of revascularization strategies.
Main Results:
- 45% of patients had coronary vessel disease; 17% had 3-vessel disease, 11% had 2-vessel disease, 5.2% had left main artery narrowing.
- 3-vessel disease was associated with the worst 5- and 10-year survival rates.
- Revascularization included coronary artery bypass grafting (19%) and stenting (5%); stenting showed a trend towards better survival than medical therapy (P=.445).
Conclusions:
- High prevalence of significant CAD exists in asymptomatic ESKD patients on hemodialysis.
- Optimal cardiovascular screening and revascularization strategies require further investigation.
- ESKD patients undergoing transplantation may benefit from pre-transplant cardiac evaluation and intervention.
Abstract:
We report the prevalence of coronary artery disease (CAD) in asymptomatic patients with end-stage kidney disease (ESKD) on hemodialysis and explore the best revascularization strategies prior to kidney transplantation. This is a retrospective single-center study, which included all patients who were candidates for kidney transplantation and underwent coronary angiography between 2003 and 2018. All included patients underwent coronary angiography without noninvasive testing and were asymptomatic cardiac-wise. Out of the 368 patients with ESRD, 45% had coronary vessel disease, 17% had 3-vessel disease, 11% had 2-vessel disease, 5.2% had significant left main artery narrowing, and 17% had single-vessel disease. Patients with 3-vessel disease had the worst survival rate at 5 and 10 years. The patients with significant 3-vessel disease or left main artery involvement underwent revascularization; 19% underwent coronary artery bypass grafting, 5% had stenting of the coronary arteries, and 4.7% were on maximal medical therapy. The patients who underwent stenting had a better survival than those on medical therapy, but the difference was not significant (P = .445). Our findings reflect a high prevalence of CAD in patients with ESKD. There is a need for further studies to evaluate benefits of cardiovascular screening in this patient population.
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