Coronary artery disease as a definitive risk factor of short-term outcome after starting hemodialysis in diabetic renal failure patients

Cardiovascular disease is a major cause of morbidity and mortality in patie nts with diabetes who are receiving dialysis. It is known that cardiac mort ality is high in the first year of hemodialysis (HD). The purpose of this s tudy was to clarify the prevalence of coronary artery disease (CAD) in pati ents with diabetes at the initiation of HD, and to investigate the relation ship between short-term outcomes after starting hemodialysis and CAD. We pe rformed coronary angiography (CAG), whether or not patient had angina, with in one month of initiation of maintenance HD in 17 of 34 consecutive unsele cted diabetic patients. We studied the two-year survival rate of those with CAD. Eleven patients (65%) were classified CAD-positive. Nine (82%) of the se 11 had multivessel disease. Clinical and hematologic factors did not dif fer significantly between the groups with and without CAD. During the two-y ear follow-up period, 28 (82%) of 34 patients survived. In patients with CA D the two-year survival rate was 60%. None of the patients without CAD died within 2 years after starting HD. These results suggest that the presence of CAD at the initiation of HD may play a critical role in short-term outco mes after starting HD. We believe that an evaluation of CAD should be perfo rmed at the initiation of HD.