N. Joki et al., ONSET OF CORONARY-ARTERY DISEASE PRIOR TO INITIATION OF HEMODIALYSIS IN PATIENTS WITH END-STAGE RENAL-DISEASE, Nephrology, dialysis, transplantation, 12(4), 1997, pp. 718-723
To determine whether the onset of coronary artery disease may precede
the initiation of dialysis in patients with end-stage renal disease, w
e performed coronary angiography within 1 month of initiation of maint
enance haemodialysis in 24 patients (age range 42-78 years; mean 63.7
+/- 11). Corollary angiography was performed regardless of the absence
or presence of angina, Fifteen patients had diabetic nephropathy, and
nine had non-diabetic nephropathy. Significant coronary stenosis was
defined as at Least 75% narrowing of the reference segment. Fifteen pa
tients (62.5%) with a total of 49 lesions were classified as the coron
ary artery disease present group. Eleven of those 15 (73.3%) had multi
vessel disease. The average number of stenotic lesions was 3.3 per pat
ient. The most common patterns of stenosis were complex (23 lesions; 4
7%), and diffuse lesions over 20 mm long (14 lesions; 29%). None of th
e clinical or haematological factors evaluated differed significantly
between the groups with and without coronary artery disease. The preva
lence of corollary artery disease was 72.7% in the symptomatic patient
s and 53.8% in the asymptomatic patients. The diagnosis of coronary ar
tery disease at the start of maintenance haemodialysis based only on c
hest symptoms and clinical factors proved to be difficult. Coronary an
giography is thus essential for evaluating corollary artery disease in
uraemic patients. Many patients with end-stage rectal disease had cor
onary artery disease prior to the start of haemodialysis.