Screening for cardiovascular disease in dialysis patients

The burden of cardiac disease in dialysis patients is high, resulting from cardiomyopathy and from coronary artery disease. Asymptomatic dialysis patients, patients with heart failure, patients with symptomatic ischaemic heart disease, and patients being evaluated for renal transplantation all require investigation to determine the presence or the extent of heart disease. Echocardiography is very useful for screening for cardiomyopathy, but should be undertaken when patients are euvolaemic. Non-invasive tests for coronary artery disease, particularly exercise-based tests, are less sensitive and less specific in dialysis patients than in the general population. Dobutamine stress echocardiography may be more sensitive in patients with renal failure than other investigations. Patients with abnormal screening tests or symptomatic ischaemic heart disease should undergo coronary angiography and subsequent revascularization procedures if indicated.