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Nephrol Dial Transplant (2001) 16: 1103-1108
© 2001 European Renal Association-European Dialysis and Transplant Association

Editorial Comment

How to diagnose and treat coronary artery disease in the uraemic patient: an update

Dietmar Elsner

Department of Internal Medicine II, University of Regensburg, Germany

Keywords: atherosclerosis; coronary artery disease; diagnosis; end-stage renal disease; myocardial infarction; myocardial ischaemia

Coronary artery disease (CAD) in end-stage renal disease (ESRD)

The poor prognosis of patients with ESRD is largely due to the high incidence of cardiovascular disease, which accounts for almost 50% of deaths [1]. Twenty per cent of these deaths are due to acute myocardial infarction. The excessive risk of CAD [2] is highest in elderly patients and in diabetics. In addition to a high prevalence of traditional risk factors, a number of uraemia-specific factors contribute to coronary atherosclerosis and myocardial ischaemia [3,4]. As there is hardly any evidence based on prospective trials in this group of patients, there is still uncertainty about the best strategy to diagnose and treat CAD in ESRD.

Diagnostic approach to CAD in ESRD

Non-invasive methods
Symptoms of angina pectoris are often misleading in patients with ESRD. There is a high prevalence of silent myocardial ischaemia. Significant CAD is found in 30–50% of asymptomatic or mildly symptomatic diabetics screened before renal transplantation [5. . . [Full Text of this Article]

Coronary angiography
Treatment of CAD in ESRD

Medical therapy
Revascularization strategies
Bypass surgery

Balloon angioplasty (PTCA)

Bypass vs PTCA
New interventional technologies

Conclusions

Notes

References


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