Relevance of conventional cardiovascular risk factors for the prediction of coronary artery disease in diabetic patients on renal replacement therapy

Koch, Michael; Gradaus, F.; Schoebel, F. C.; Leschke, M.; Grabensee, B.

doi:10.1093/ndt/12.6.1187

Cited by 84 publications

(46 citation statements)

References 1 publication

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“…Braun et al (14) reported that 75% of diabetic dialysis patients with angiographically proven significant CAS had no symptoms. Koch et al (15) reported that only nine (26.3%) of 38 HD patients with CAS (Ͼ50% stenosis) had symptoms, and a CAG study performed by Pidgeon et al (16) on dialysis patients before renal transplantation showed that only 43% had symptoms. In contrast to these reports on occult CAS in CKD patients who were already on long-standing RRT, there have been few reports concerning the prevalence of CAS in patients with CKD just before the initiation of RRT.…”

Section: Discussionmentioning

confidence: 99%

High Prevalence of Occult Coronary Artery Stenosis in Patients with Chronic Kidney Disease at the Initiation of Renal Replacement Therapy

Ohtake¹,

Kobayashi²,

Moriya³

et al. 2005

Journal of the American Society of Nephrology

262

166

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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.

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Section: Discussionmentioning

confidence: 99%

High Prevalence of Occult Coronary Artery Stenosis in Patients with Chronic Kidney Disease at the Initiation of Renal Replacement Therapy

Ohtake¹,

Kobayashi²,

Moriya³

et al. 2005

Journal of the American Society of Nephrology

262

166

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“…6 In fact, diagnosing CAD based only on classical symptoms and clinical factors in patients with CKD is extremely difficult .7 For example, the isolated analysis of the electrocardiogram (ECG) of HD patients has shown that the presence of a ST segment depression during sessions was efficient in diagnosing CAD in symptomatic patients. 8 That exam had sensitivity of 67% and specificity of 52% in patients undergoing renal replacement therapy.…”

Section: Assessment Of Atherosclerosis In Ckdmentioning

confidence: 99%

Avaliação e manejo da doença cardiovascular em pacientes com doença renal crônica

Bucharles¹,

Varela²,

Barberato³

et al. 2010

J. Bras. Nefrol.

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Cardiovascular disease is the leading cause of death in the set of chronic kidney disease (CKD) patients, whether on renal replacement therapy or conservative treatment. A better understanding of cardiovascular risk factors, diagnostic approach and management are central keys to develop strategies to reduce cardiovascular mortality among those patients. This review article discusses some aspects of pathophysiology, investigation methods and current treatment of cardiovascular disease in CKD patients.

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“…Therefore these results only reflect the potential for clinical symptoms to detect restenosis in symptomatic patients; they are not relevant to the primary detection of coronary artery disease where increased numbers of asymptomatic patients are to be expected because of the high prevalence of neuropathy. 26 The rate of angiographic restenosis is lower than that reported in previous studies (69% to 100%). [8][9][10] This is probably a result of selection bias, as in these studies only patients with clinical symptoms were re-evaluated angiographically.…”

Section: Procedural Variables In Coronary Angiography and Angioplastymentioning

confidence: 54%

An unusual palliative shunt for cyanotic congenital heart disease

Sreeram¹,

Henneveld²,

Hitchcock³

1997

Heart

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Objective-To assess the rate of angiographic restenosis in patients with end stage renal disease after elective coronary angioplasty. Design-A retrospective case-control study of 20 patients with end stage renal disease and 20 sex and age matched controls without renal disease, who had undergone primarily successful coronary angioplasty. Control coronary angiography was performed regardless of worsening or renewed incidence of anginal symptoms. Main outcome measures-Group

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Relevance of conventional cardiovascular risk factors for the prediction of coronary artery disease in diabetic patients on renal replacement therapy

Abstract: Clinical symptoms as well as the cardiovascular risk profile are not valid predictors of CAD in diabetic patients with chronic renal failure. Therefore coronary angiography should be performed in all diabetic patients prior to renal transplantation.

Cited by 84 publications

References 1 publication

High Prevalence of Occult Coronary Artery Stenosis in Patients with Chronic Kidney Disease at the Initiation of Renal Replacement Therapy

High Prevalence of Occult Coronary Artery Stenosis in Patients with Chronic Kidney Disease at the Initiation of Renal Replacement Therapy

Avaliação e manejo da doença cardiovascular em pacientes com doença renal crônica

An unusual palliative shunt for cyanotic congenital heart disease

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