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NDT Advance Access originally published online on January 30, 2008
Nephrology Dialysis Transplantation 2008 23(7):2324-2328; doi:10.1093/ndt/gfm954
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© The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Decreased coronary flow reserve in haemodialysis patients

Shinnichiro Niizuma1, Shin Takiuchi1, Sadanori Okada2, Takeshi Horio1, Kei Kamide1, Hiroto Nakata1, Fumiki Yoshihara1, Satoko Nakamura1, Yuhei Kawano1, Hajime Nakahama1, Yoshitaka Iwanaga3 and Satoshi Nakatani3

1 Division of Hypertension and Nephrology 2 Division of Atherosclerosis and Diabetes 3 Division of Cardiology, National Cardiovascular Center, Fujishirodai 5-7-1, Suita 565-8565, Japan

Correspondence and offprint requests to: Hajime Nakahama, Division of Hypertension and Nephrology, National Cardiovascular Center, Fujishirodai 5-7-1, Suita 565-8565, Japan. E-mail: hnakaham{at}hsp.ncvc.go.jp



  Abstract

Background. Coronary flow reserve (CFR) reflects the functional capacity of microcirculation to adapt to blood demand during increased cardiac work.

Methods. Forty-one patients who had already undergone coronary angiography were studied. They consisted of 21 haemodialysis patients with no significant left anterior descending coronary artery (LAD) stenosis and 20 non-renal failure patients without LAD stenosis. We performed transthoracic Doppler recording of diastolic coronary flow velocity in the LAD at baseline and after maximal vasodilatation by adenosine triphosphate (ATP) infusion. CFR was defined as the ratio of hyperaemic to basal averaged peak flow velocity.

Results. Although the peak coronary velocities during hyperaemia were similar between the two groups, CFR was smaller in haemodialysis (HD) patients than in control subjects (1.96 ± 04 versus 2.3 ± 0.5, P = 0.001) due to the higher baseline peak coronary velocities in the former.

Conclusions. The elevated baseline peak coronary velocity may be caused by cardiac hypertrophy and anaemia in HD patients.

Keywords: anaemia; coronary flow reserve; echocardiography; haemodialysis; left ventricular

Received for publication: 3. 9.07
Accepted in revised form: 26.12.07


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