Ischemic Heart Disease in Patients with End-Stage Kidney Disease

Abstract

Background: It was recently reported that the severity of coronary and carotid atherosclerosis in patients with end-stage kidney disease (ESKD) has improved over the last two decades. However, the frequency of coronary artery events observed at the initiation of dialysis remains high. Summary: Recently, 5 different clinical types of acute myocardial infarction (MI) were introduced in the third universal definition of MI. Type 2 MI, known as secondary MI, is a more heterogeneous entity, where a condition other than coronary artery narrowing contributes to an acute imbalance in oxygen supply and demand. In patients with chronic kidney disease, it has been demonstrated that type 2 MI is more common than type 1 MI, which is associated with coronary occlusive disease. It is suspected that patients with ESKD also often have type 2 MI. Factors associated with incremental increases in oxygen demand may cause myocardial ischemia in ESKD. Key Messages: Significant epicardial coronary narrowing might not be a necessary precursor of myocardial ischemia in ESKD. To prevent ischemic heart disease and improve prognosis in patients with ESKD, we need to pay attention not only to coronary stenotic lesions, but also to the factors associated with the induction of an imbalance in myocardial oxygen supply and demand.

Diminishing dry weight is strongly associated with all-cause mortality among long-term maintenance prevalent dialysis patients

“…Recently, another mechanism of myocardial ischemia was proposed in dialysis patients and the general population. Without significant coronary artery stenosis, there could be an insufficient oxygen supply to the myocardium because of hypertension, excess volume, left ventricular hypertrophy, and anemia (MI secondary to an ischemic imbalance) [ 9 , 10 ]. Aortic valve stenosis has also become an important problem in dialysis patients because of aging and end-stage kidney disease, which progress to aortic valve stenosis due to hyperphosphatemia or calcium over supplementation [ 11 ].…”

Novel Perspectives in Chronic Kidney Disease-Specific Cardiovascular Disease

“…Ischemic heart disease due to coronary artery atherosclerosis is more prevalent in patients with CKD [ 17 ], demonstrating accelerated progression. Although there is no epidemiological relationship between the duration of renal replacement therapy, specifically haemodialysis, and the worsening of coronary artery disease [ 18 ], the incidence of myocardial infarction is high in the first week [ 19 ] and year [ 20 ] after commencing HD with uniformly poor outcomes. A recent meta-analysis demonstrated fewer cardiovascular events in patients undergoing peritoneal dialysis, but mortality was greater [ 21 ].…”

Frequency of Ischemic Heart Disease in Patients of End Stage Renal Disease

“…However, CKD itself is deliberated as an autonomous risk factor in advancement of chronic CVD due to a number of pathological processes associated with it i.e. increased vascular calcification 11 , inflammatory process, uremic environment, endothelial dysfunction, high oxidative stress 12,13 , over hydration & hypertension, cardiac hypertrophy and anemia 14 .…”