Assessment of Coronary Stenosis by a 16-Slice MDCT Scanner in Asymptomatic Diabetic Patients Starting Dialysis Therapy

Iio, Kenichiro; Nagasawa, Yasuyuki; Kimura, Tomonori; Yamasaki, Kazuhiko; Takeda, Yoshihiro; Hamano, Takayuki; Iwatani, Hirotsugu; Sumitsuji, Satoru; Nagai, Yoshiyuki; Ito, Takahito; Imai, Enyu; Hayashi, Terumasa

doi:10.1159/000139992

Cited by 14 publications

(14 citation statements)

References 42 publications

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“…Since only very limited data on CTA in dialysis patients is currently available, [23] a study that assesses the diagnostic accuracy of CTA, before strengthening the hypothesis that CTA indeed might be of clinical value, was in our opinion not ethical. Therefore the purpose of this study was first to assess whether CTA gives interpretable results and furthermore whether these findings relate to clinical end-points.…”

Section: Discussionmentioning

confidence: 98%

CT Coronary Angiography Is Feasible for the Assessment of Coronary Artery Disease in Chronic Dialysis Patients, Despite High Average Calcium Scores

et al. 2013

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PurposeSignificant obstructive coronary artery disease (CAD) is common in asymptomatic dialysis patients. Identifying these high risk patients is warranted and may improve the prognosis of this vulnerable patient group. Routine catheterization of incident dialysis patients has been proposed, but is considered too invasive. CT-angiography may therefore be more appropriate. However, extensive coronary calcification, often present in this patient group, might hamper adequate lumen evaluation. The objective of this study was to assess the feasibility of CT-angiography in this patient group.MethodsFor this analysis all patients currently participating in the ICD2 trial (ISRCTN20479861), with no history of PCI or CABG were included. The major epicardial vessels were evaluated on a segment basis (segment 1–3, 5–8, 11 and 13) by a team consisting of an interventional and an imaging specialist. Segments were scored as not significant, significant and not interpretable.ResultsA total of 70 dialysis patients, with a mean age of 66±8 yrs and predominantly male (70%) were included. The median calcium score was 623 [79, 1619].Over 90% of the analyzed segments were considered interpretable. The incidence of significant CAD on CT was 43% and was associated with cardiovascular events during follow-up. The incidence of cardiovascular events after 2-years follow-up: 36% vs. 0% in patients with no significant CAD (p<0.01).ConclusionDespite the high calcium scores CT-angiography is feasible for the evaluation of the extent of CAD in dialysis patients. Moreover the presence of significant CAD on CT was associated with events during follow-up.

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Section: Discussionmentioning

confidence: 98%

CT Coronary Angiography Is Feasible for the Assessment of Coronary Artery Disease in Chronic Dialysis Patients, Despite High Average Calcium Scores

et al. 2013

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“…Coronary CT has good correlation with angiographic coronary disease 34, 39 , and an abnormal coronary CT is an independent risk factor for adverse CV outcomes in kidney transplant candidates 38, 40 . These results are from relatively small studies and require validation in larger trials with a more diverse population before the widespread use of coronary CT can be recommended as a CV disease screening method in renal transplant candidates.…”

Section: Cardiovascular Diseasementioning

confidence: 96%

Non-immunological complications following kidney transplantation

2019

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Kidney transplantation (KT) is the most effective way to decrease the high morbidity and mortality of patients with end-stage renal disease. However, KT does not completely reverse the damage done by years of decreased kidney function and dialysis. Furthermore, new offending agents (in particular, immunosuppression) added in the post-transplant period increase the risk of complications. Cardiovascular (CV) disease, the leading cause of death in KT recipients, warrants pre-transplant screening based on risk factors. Nevertheless, the screening methods currently used have many shortcomings and a perfect screening modality does not exist. Risk factor modification in the pre- and post-transplant periods is of paramount importance to decrease the rate of CV complications post-transplant, either by lifestyle modification (for example, diet, exercise, and smoking cessation) or by pharmacological means (for example, statins, anti-hyperglycemics, and so on). Post-transplantation diabetes mellitus (PTDM) is a major contributor to mortality in this patient population. Although tacrolimus is a major contributor to PTDM development, changes in immunosuppression are limited by the higher risk of rejection with other agents. Immunosuppression has also been implicated in higher risk of malignancy; therefore, proper cancer screening is needed. Cancer immunotherapy is drastically changing the way certain types of cancer are treated in the general population; however, its use post-transplant is limited by the risk of allograft rejection. As expected, higher risk of infections is also encountered in transplant recipients. When caring for KT recipients, special attention is needed in screening methods, preventive measures, and treatment of infection with BK virus and cytomegalovirus. Hepatitis C virus infection is common in transplant candidates and in the deceased donor pool; however, newly developed direct-acting antivirals have been proven safe and effective in the pre- and post-transplant periods. The most important and recent developments on complications following KT are reviewed in this article.

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“…However, patients with an eGFR <30 mL/min/1.73 m 2 were excluded from this trial, precluding generalization to patients with advanced CKD and ESRD. The evidence comparing the accuracy of CCTA with ICA in an ESRD population is limited [71, 77, 84]. The elevated calcification burden constitutes the major barrier to the use of CCTA in these patients, as heavily calcified plaques cause blooming artefacts and partial volume effects that blur the coronary lumen [80, 85, 86] (Figure 2).…”

Section: Assessment Of Cadmentioning

confidence: 99%

The assessment of coronary artery disease in patients with end-stage renal disease

Poli

Gulsin

Burton

et al. 2019

Clinical Kidney Journal

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Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality among patients with end-stage renal disease (ESRD). Clustering of traditional atherosclerotic and non-traditional risk factors drive the excess rates of coronary and non-coronary CVD in patients with ESRD. Coronary artery disease (CAD) is a key disease process, present in ∼50% of the haemodialysis population ≥65 years of age. Patients with ESRD are more likely to be asymptomatic, posing a challenge to the correct identification of CAD, which is essential for appropriate risk stratification and management. Given the lack of randomized clinical trial evidence in this population, current practice is informed by observational data with a significant potential for bias. For this reason, the most appropriate approach to the investigation of CAD is the subject of considerable discussion, with practice patterns largely varying between different centres. Traditional imaging modalities are limited in their diagnostic accuracy and prognostic value for cardiac events and survival in patients with ESRD, demonstrated by the large number of adverse cardiac outcomes among patients with negative test results. This review focuses on the current understanding of CAD screening in the ESRD population, discussing the available evidence for the use of various imaging techniques to refine risk prediction, with an emphasis on their strengths and limitations.

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Assessment of Coronary Stenosis by a 16-Slice MDCT Scanner in Asymptomatic Diabetic Patients Starting Dialysis Therapy

Cited by 14 publications

References 42 publications

CT Coronary Angiography Is Feasible for the Assessment of Coronary Artery Disease in Chronic Dialysis Patients, Despite High Average Calcium Scores

CT Coronary Angiography Is Feasible for the Assessment of Coronary Artery Disease in Chronic Dialysis Patients, Despite High Average Calcium Scores

Non-immunological complications following kidney transplantation

The assessment of coronary artery disease in patients with end-stage renal disease

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