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Nephrol Dial Transplant (2003) 18: 1993-1998
© 2003 European Renal Association-European Dialysis and Transplant Association

Invited Comment

Cardiovascular complications in the diabetic patient with renal disease: an update in 2003

Ralf Dikow and Eberhard Ritz

Department of Internal Medicine, Ruperto Carola University Heidelberg, Germany

Correspondence and offprint requests to: Professor Eberhard Ritz, Department of Internal Medicine, University of Heidelberg, Bergheimer Strasse 58, D-69115 Heidelberg, Germany. Email: Prof.E.Ritz@t-online.de

Keywords: beta-blockers; coronary arterial bypass grafting; coronary heart disease; diabetes; diabetic nephropathy; myocardial infarction; glycaemic control; PTCA

The first 150 words of the full text of this article appear below.

Epidemiology

Coronary heart disease [defined as myocardial infarction, angina, history of bypass surgery, percutaneous transluminal coronary angiography (PTCA) or pathology on coronary angiography] is frequently found in patients starting dialysis. Stack and Bloembergen [1] examined a national random sample of 4025 patients entering renal replacement programmes in the USA. The prevalence of coronary heart disease was 38% and it was significantly more common in diabetic patients (46.4%) than in non-diabetic patients (32.2%). This difference was highly significant on multivariate analysis.

Much of the cardiac pathology is acquired prior to dialysis. This is documented by the high frequency of coronary lesions, i.e. 30–40%, which is found when diabetic patients undergo coronarography before they are put on the waiting list for transplantation. The conclusion that much of the cardiac pathology is acquired even before the pre-terminal phase of renal disease is supported by the Canadian multicentre observation cohort where the prevalence . . . [Full Text of this Article]

Manifestations of heart disease

Acute coronary syndrome

Predictors of cardiac risk

Prevention

Intervention

Conclusion


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