Document Detail


High prevalence of occult coronary artery stenosis in patients with chronic kidney disease at the initiation of renal replacement therapy: an angiographic examination.
MedLine Citation:
PMID:  15743997     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The prevalence of coronary artery stenosis (CAS) at the initiation of renal replacement therapy (RRT) in patients with chronic kidney disease (CKD) and no previous history of angina and/or myocardial infarction (MI) has not been fully elucidated. The prevalence of significant CAS was evaluated in 30 asymptomatic stage 5 CKD patients without a history of angina and/or MI by coronary angiography at the initiation of RRT. The correlations of various parameters with the prevalence of CAS were also examined. Atherosclerotic surrogate markers, including intima-media thickness of carotid artery and ankle-brachial BP index (ABI), were also evaluated. Significant CAS (>50% stenosis) was seen in 16 (53.3%) of 30 asymptomatic CKD patients on coronary angiography at the start of RRT. Stress cardiac scintigraphy was not effective for detecting hidden cardiac ischemia among the CKD patients. Univariate analysis showed that diabetes (P = 0.01), left ventricular mass index (P = 0.04), hyperlipidemia (P = 0.04), total cholesterol (P = 0.02), LDL cholesterol (P < 0.01), intima-media thickness (P = 0.04), and fibrinogen (P = 0.01) were positively correlated with the presence of CAS, whereas ABI (P < 0.01) showed a negative correlation with CAS. Stepwise logistic regression analysis revealed that diabetes and fibrinogen were significant and independent risk factors for CAS in asymptomatic CKD patients who started RRT. The results clearly demonstrated that despite the absence of cardiac events, stage 5 CKD patients are already in a very high risk group for CAS at the initiation of RRT, which was also closely associated with a significant decrease in ABI.
Authors:
Takayasu Ohtake; Shuzo Kobayashi; Hidekazu Moriya; Kousuke Negishi; Kouji Okamoto; Kyoko Maesato; Shigeru Saito
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2005-03-02
Journal Detail:
Title:  Journal of the American Society of Nephrology : JASN     Volume:  16     ISSN:  1046-6673     ISO Abbreviation:  J. Am. Soc. Nephrol.     Publication Date:  2005 Apr 
Date Detail:
Created Date:  2005-03-24     Completed Date:  2005-09-13     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:  1141-8     Citation Subset:  IM    
Affiliation:
Department of Nephrology, and Kidney & Dialysis Center, Shonan Kamakura General Hospital, 1202-1 Yamazaki, Kamakura, Kanagawa 247-8533, Japan. ohtake@shonankamakura.or.jp
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Ankle / blood supply
Blood Pressure
Brachial Artery / physiopathology
Carotid Arteries / ultrasonography
Chronic Disease
Coronary Angiography*
Coronary Artery Disease / complications*,  epidemiology*,  radiography
Female
Humans
Kidney Diseases / complications*,  therapy*,  ultrasonography
Logistic Models
Male
Middle Aged
Prevalence
Renal Replacement Therapy*
Tunica Intima / ultrasonography
Tunica Media / ultrasonography
Comments/Corrections
Comment In:
J Am Soc Nephrol. 2005 Apr;16(4):843-5   [PMID:  15772247 ]

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