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Undiagnosed Coronary Artery Disease in Hemodialysis-Initiating Patients

Hirohito Sugawara1, Kiryu Yoshida1, Hiroya Shigematsu1

  • 1Division of Nephrology, Department of Internal Medicine, Showa Medical University Northern Yokohama Hospital.

Journal of Atherosclerosis and Thrombosis
|June 15, 2025
PubMed

Insights

Undiagnosed coronary artery disease (CAD) affects nearly half of patients starting hemodialysis. Smoking history, statin use, and low albumin/HDL-C levels were linked to CAD in this end-stage renal disease population.

Area of Science:

  • Cardiology
  • Nephrology
  • Radiology

Background:

  • End-stage renal disease (ESRD) patients on hemodialysis have a high risk of cardiovascular disease.
  • Undiagnosed coronary artery disease (CAD) is a significant concern in this population.
  • Understanding CAD prevalence and risk factors is crucial for patient management.

Purpose of the Study:

  • To update the understanding of undiagnosed CAD in Japanese patients initiating hemodialysis.
  • To investigate CAD prevalence, associated risk factors, and coronary lesion distribution.
  • To analyze temporal trends in CAD prevalence and coronary artery calcification scores (CACS).

Main Methods:

  • Retrospective cross-sectional study of 272 patients undergoing hemodialysis for ESRD between 2009-2023.
  • Coronary computed tomography (CCT) used for initial screening and confirmation (with coronary angiography/CAG).
  • Logistic regression analysis identified factors associated with CAD; temporal trends in CACS and prevalence were assessed.

Main Results:

  • CAD was present in 47% of patients, with lesions predominantly in the left anterior descending artery (73%).
  • Coronary artery calcification score (CACS) >65 increased from 2012-2014 to 2015-2017, then stabilized.
  • Smoking history, statin use, low albumin, and low HDL-C were independently associated with CAD.

Conclusions:

  • Traditional CAD risk factors seen in the general population were not significant predictors in this ESRD cohort.
  • This highlights unique pathophysiological mechanisms of CAD in patients undergoing hemodialysis.
  • Further research is needed to identify specific risk factors and improve screening strategies.
Abstract

Keywords:
Chronic kidney diseaseCoronary angiographyCoronary artery diseaseCoronary computed tomographyHemodialysis

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