Cardiovascular disease in end-stage renal disease patients

This study evaluates risk factor monitoring in end-stage renal disease (ESR D) patients with cardiovascular disease. Death rates from cardiovascular di sease in ESRD patients are 20 to 40 times higher than in the general popula tion, and 72% of ESRD patients with an acute myocardial infarction (AMI) ar e dead within 2 years of follow-up. Patients who have sustained an AMI rare ly receive definitive testing to assess coronary circulation, and cardiac c atheterization rates and revascularization rates are low, even after the hi gh-risk event of an AMI. Risk factor intervention to treat lipid disorders in the ESRD population has received little attention, with the USRDS report ing that In 1998, 58% of dialysis and 64% of transplant patients had no lip id monitoring performed within a year. Of those tested, only 33% of dialysi s and 27% of transplant patients had two or more tests within 1 year. Glyce mic control monitoring in the form of HbA1c, recommended for diabetes manag ement, is also underutilized in ESRD patients, with fewer than half receivi ng a single test within 1 year and only 10% receiving three or more tests. This raises concerns that diabetic glycemic control monitoring may be subop timal in the ESRD population. The use of diabetic eye examinations and diab etic glucose monitoring is also low, as are influenza vaccination rates. Th ese data suggest that the clinical care of cardiovascular disease in the ES RD patients needs more attention. (C) 2001 by the National Kidney Foundatio n, Inc.