Document Detail


Diagnosis and management of coronary artery disease in patients with end-stage renal disease on hemodialysis.
MedLine Citation:
PMID:  8915964     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Cardiovascular disease accounts for almost half of the total mortality in patients with ESRD. Ischemic heart disease is responsible for many cardiovascular deaths, with myocardial infarction accounting for approximately 15% and sudden cardiac death or severe left ventricular dysfunction accounting for much of the remainder. The markedly increased prevalence of atherosclerotic cardiovascular disease in patients with ESRD is influenced, at least in part, by numerous risk factors for atherosclerosis, with hypertension, diabetes mellitus, and hypercholesterolemia being particularly important. Because atherosclerotic coronary artery disease (CAD), whether symptomatic or asymptomatic, is associated with an increased incidence of allograft failure and mortality, the results of this study suggest the need for careful evaluation for the presence of CAD in those persons who are under consideration for renal transplantation. Candidates with angina pectoris, previous myocardial infarction, or congestive heart failure are at particularly high risk of a cardiac event, and, therefore, should routinely undergo pretransplant coronary angiography and subsequent surgical revascularization if angina is refractory to medical therapy or CAD is extensive. In contrast, although young, nondiabetic transplant candidates without symptoms or electrocardiographic evidence of CAD have an increased relative risk of cardiac death when compared with age-matched control subjects, their absolute risk of such an event is very low. As a result, they do not require a cardiac evaluation before transplantation. For the remaining transplant candidates at neither low nor high risk of a fatal or nonfatal cardiac event (i.e., those at intermediate risk), the authors of this study routinely perform (1) thallium imaging with dipyridamole or (2) two-dimensional echocardiography with intravenous dobutamine. If the result of these investigations are normal, transplantation proceeds; if abnormal, coronary angiography is performed, followed by surgical revascularization if CAD is extensive. Percutaneous transluminal coronary angioplasty is not recommended in patients with ESRD because it appears to be accompanied by a high likelihood of acute and chronic complications. Although it is hoped that surgical revascularization before renal transplantation improves allograft and patient survival, prospectively obtained data proving that this, in fact, is true do not exist.
Authors:
J A de Lemos; L D Hillis
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Journal of the American Society of Nephrology : JASN     Volume:  7     ISSN:  1046-6673     ISO Abbreviation:  J. Am. Soc. Nephrol.     Publication Date:  1996 Oct 
Date Detail:
Created Date:  1997-02-26     Completed Date:  1997-02-26     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9013836     Medline TA:  J Am Soc Nephrol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  2044-54     Citation Subset:  IM    
Affiliation:
Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas 75235-9047, USA.
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MeSH Terms
Descriptor/Qualifier:
Coronary Artery Disease / complications,  physiopathology
Coronary Disease / complications,  diagnosis*,  therapy*
Humans
Kidney Failure, Chronic / complications*,  therapy*
Kidney Transplantation
Renal Dialysis*
Risk Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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