CLINICAL AND ECHOCARDIOGRAPHIC DISEASE IN PATIENTS STARTING END-STAGERENAL-DISEASE THERAPY

End-stage renal disease (ESRD) patients have a high cardiovascular mor tality rate. Precise estimates of the prevalence, risk factors and pro gnosis of different manifestations of cardiac disease are unavailable. In this study a prospective cohort of 433 ESRD patients was followed from the start of ESRD therapy for a mean of 41 months. Baseline clini cal assessment and echocardiography were performed on all patients. Th e major outcome measure was death while on dialysis therapy. Clinical manifestations of cardiovascular disease were highly prevalent at the start of ESRD therapy: 14% had coronary artery disease, 19% angina pec toris, 31% cardiac failure, 7% dysrhythmia and 8% peripheral vascular disease. On echocardiography 15% had systolic dysfunction, 32% left ve ntricular dilatation and 74% left ventricular hypertrophy. The overall median survival time was 50 months. Age, diabetes mellitus, cardiac f ailure, peripheral vascular disease and systolic dysfunction independe ntly predicted death in all time frames. Coronary artery disease was a ssociated with a worse prognosis in patients with cardiac failure at b aseline. High left ventricular cavity volume and mass index were indep endently associated with death after two years. The independent associ ations of the different echocardiographic abnormalities were: systolic dysfunction-older age and coronary artery disease; left ventricular d ilatation-male gender, anemia, hypocalcemia and hyperphosphatemia; lef t ventricular hypertrophy-older age, female gender, wide arterial puls e pressure, low blood urea and hypoalbuminemia. We conclude that clini cal and echocardiographic cardiovascular disease are already present i n a very high proportion of patients starting ESRD therapy and are ind ependent mortality factors.