ONSET OF CORONARY-ARTERY DISEASE PRIOR TO INITIATION OF HEMODIALYSIS IN PATIENTS WITH END-STAGE RENAL-DISEASE

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.