Related Experiment Videos
New perspectives on coronary artery disease in hemodialysis patients
Insights
Angina pectoris affects 17% of patients on maintenance hemodialysis, with 11% experiencing new crescendo angina. Coronary artery bypass surgery effectively treats these patients, with concurrent hemodialysis simplifying post-operative care.
Area of Science:
- Nephrology
- Cardiology
- Internal Medicine
Background:
- Long-term maintenance hemodialysis patients often present with cardiovascular complications.
- Angina pectoris is a significant concern in this population, impacting quality of life and requiring intervention.
Purpose of the Study:
- To determine the prevalence of angina pectoris in patients undergoing maintenance hemodialysis.
- To investigate the incidence of new onset crescendo angina and its correlation with coronary artery disease.
- To evaluate the efficacy of coronary artery bypass surgery and the feasibility of concurrent hemodialysis.
Main Methods:
- Prospective analysis of 64 patients on maintenance hemodialysis over a one-year period.
- Assessment of angina symptoms, risk factors (cardiomegaly, hypertension), and cardiac catheterization findings.
- Evaluation of outcomes following coronary artery bypass surgery, including functional status and need for antianginal medications.
Main Results:
- 17% of patients had angina pectoris (6% chronic stable, 11% new onset crescendo angina).
- Cardiomegaly and hypertension were common in unstable angina patients.
- Four out of five patients with angina had surgically correctable coronary artery lesions.
- Coronary artery bypass surgery improved functional status in all treated patients.
- Concurrent hemodialysis during bypass simplified postoperative management.
Conclusions:
- Angina is prevalent in hemodialysis patients, with a notable incidence of new-onset crescendo angina.
- Surgically correctable coronary lesions are frequent in this group.
- Coronary artery bypass surgery is an effective treatment, and concurrent hemodialysis is a safe and beneficial option.
Abstract:
Between July 1, 1979, and July 1, 1980, we treated 64 patients with long-term maintenance hemodialysis. Of these, 11 (17%) had angina pectoris, four of them (6%) chronic stable angina and seven (11%) new onset of crescendo angina. The most common risk factors in the group with unstable angina were cardiomegaly and hypertension. Of the five patients who underwent cardiac catheterization, proximal occlusive disease was seen in four and these four had good left ventricular function. Three patients underwent coronary artery bypass, which successfully improved their functional status to a class I or II without any antianginal medicines. Concurrent hemodialysis was performed during heart-lung bypass in one patient. The need for dialysis postoperatively was easily delayed for 72 hours without detriment to this patient. We reached the following conclusions: (1) The prevalence of angina in a stable hemodialysis population was 17% in a one-year analysis period. (2) The incidence of new onset of crescendo angina, which potentially requires coronary angiography, was 11% over the same one-year period. (3) The presence of surgically correctable lesions in these cases is high. (4) Concurrent hemodialysis during coronary artery bypass simplifies postoperative fluid and electrolyte management and prevents surgical bleeding.