To determine the prognosis and risk factors for ischemic heart disease
in chronic uremia, a cohort of 432 dialysis patients were followed pr
ospectively from start of dialysis therapy until death or renal transp
lantation. Baseline demographic, clinical and echocardiographic data w
ere obtained. After the initiation of dialysis laboratory data were co
llected at monthly intervals, and clinical and echocardiographic data
at yearly intervals. Twenty-two percent of patients (N = 95) had eithe
r a history of angina pectoris or myocardial infarction on starting di
alysis therapy. Median time to onset of heart failure was 24 months in
those with ischemic heart disease on initiation of dialysis, compared
to 55 months in those without (P < 0.0001). This effect was independe
nt of age, diabetes and underlying cardiomyopathy. Median survival was
44 months in those with ischemic disease compared to 56 months in tho
se without (P = 0.0001). This adverse impact was independent of age an
d diabetes mellitus but, when cardiac failure was added to the Cox's m
odel, ischemic heart disease was no longer an independent predictor of
survival. De novo ischemic heart disease, not evident on starting dia
lysis therapy, occurred in 41 (9%) patients. When compared to patients
who never developed ischemic disease (N = 296; 69%), significant and
independent predictors of de novo disease were older age (P = 0.0007),
diabetes mellitus (P = 0.0001), high blood pressure during follow up
on dialysis (P = 0.02) and hypoalbuminemia (P = 0.03), whereas anemia
was not an independent predictor. LV mass index was 174 +/- 7 g/m(2) i
n those who developed de novo ischemic disease compared to 155 +/- 3 g
/m(2) (P < 0.001) in those who did not. Concentric LV hypertrophy, LV
dilation and systolic dysfunction were independent risk factors for de
novo ischemic heart disease. We conclude that ischemic heart disease
occurs frequently in dialysis patients, that its adverse impact is med
iated through the development of heart failure, and that the most impo
rtant, potentially reversible risk factors are hypertension, hypoalbum
inemia, and underlying cardiomyopathy.