Nephrology Dialysis Transplantation, Vol 12, Issue 6 1187-1192, Copyright © 1997 by Oxford University Press
M Koch, F Gradaus, F Schoebel, M Leschke and B Grabensee
Background. Diabetic patients undergoing renal
replacement therapy have a high cardiovascular mortality. As the rate of
patients with diabetic nephropathy rises, adequate risk stratification
subsequent to renal transplantation is warranted. It was the aim of our
study to elucidate whether conventional risk factors are valid predictors
of coronary artery disease in this group of patients with chronic renal
failure subsequent to transplantation. Methods and
Results. Between 1989 and 1993, 105 consecutive diabetic
patients (70 men, 35 women, 77 type I and 28 type II diabetics, mean age
43±12 years) were examined during the first six months of
dialysis treatment. Coronary angiography was performed in all patients
regardless of clinical symptoms of coronary artery disease (CAD). In 38
patients (36%) CAD was documented (single-vessel disease: 17 patients,
double-vessel disease: 6 patients, triple-vessel disease: 15 patients).
Manifestations of coronary atherosclerosis were seen in 49 patients (47%).
Angina pectoris was present in 9 out of 38 patients (24%), the sensitivity
to detect CAD was 43% and 52% for ST-segment depression assessed at rest.
Risk factors for atherosclerosis like hypertension, smoking, cholesterol
(total cholesterol, HDL-,LDL-cholesterol), triglycerides as well as
concentrations of lipoprotein (a) and fibrinogen were not significantly
different in patients with or without coronary artery disease.
Atherosclerotic manifestations of cerebral and peripheral arteries as well
as manifestations of diabetic microangiopathy like retinopathy did not
correlate with the prevalence of CAD. In 11 out of 38 patients (29%)
cardiac interventions (3 x CABG, 8 x PTCA) were performed. All of them were
defined as transplantable after myocardial revascularisation.
Conclusions. Clinical symptoms as well as the
cardiovascular risk profile are not valid predictors of CAD in diabetic
patients with chronic renal failure. Therefore coronary angiography should
be performed in all diabetic patients prior to renal transplantation.
Keywords: cardiovascular risk factors; coronary
angiography; coronary artery disease; diabetes mellitus; end stage renal
failure
ORIGINAL ARTICLES
Relevance of conventional cardiovascular risk factors for the prediction of coronary artery disease in diabetic patients on renal replacement therapy
Department of Internal Medicine, Clinic of Nephrology and Rheumatology, Clinic of Cardiology, Pneumology and Angiology, Heinrich Heine University, PO Box 101007, D-40001 Dusseldorf, Germany; Corresponding author
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