Nephrology Dialysis Transplantation, Vol 12, Issue 4 718-723, Copyright © 1997 by Oxford University Press
N Joki, H Hase, R Nakamura and T Yamaguchi
To determine whether the onset of coronary artery disease may precede the
initiation of dialysis in patients with end-stage renal disease, we
performed coronary angiography within 1 month of initiation of maintenance
haemodialysis in 24 patients (age range 42-78 years; mean 63.7 +/- 11).
Coronary angiography was performed regardless of the absence or presence of
angina. Fifteen patients had diabetic nephropathy, and nine had
non-diabetic nephropathy. Significant coronary stenosis was defined as at
least 75% narrowing of the reference segment. Fifteen patients (62.5%) with
a total of 49 lesions were classified as the coronary artery disease
present group. Eleven of those 15 (73.3%) had multivessel disease. The
average number of stenotic lesions was 3.3 per patient. The most common
patterns of stenosis were complex (23 lesions; 47%), and diffuse lesions
over 20 mm long (14 lesions; 29%). None of the clinical or haematological
factors evaluated differed significantly between the groups with and
without coronary artery disease. The prevalence of coronary artery disease
was 72.7% in the symptomatic patients and 53.8% in the asymptomatic
patients. The diagnosis of coronary artery disease at the start of
maintenance haemodialysis based only on chest symptoms and clinical factors
proved to be difficult. Coronary angiography is thus essential for
evaluating coronary artery disease in uraemic patients. Many patients with
end-stage renal disease had coronary artery disease prior to the start of
haemodialysis.
ORIGINAL ARTICLES
Onset of coronary artery disease prior to initiation of haemodialysis in patients with end-stage renal disease
Third Department of Internal Medicine, Toho University Ohashi Hospital, Tokyo, Japan.
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