Prevalence and clinical correlates of coronary artery disease among new dialysis patients in the United States: A cross-sectional study

Despite the high prevalence of coronary artery disease (CAD) among patients with end-stage renal disease (ESRD), few studies have identified clinical correlates using national data. The purpose of this study was to determine the prevalence and clinical associations of CAD in a national random sample of new ESRD in the United States in 1996/ 1997 (n = 4025). Data on demogra phic characteristics and comorbidities were obtained from the Dialysis Morb idity and Mortality Study, Wave 2. The principal outcome was CAD, defined a s the presence of a previous history of CAD, myocardial infarction, or angi na, coronary artery bypass surgery, coronary angioplasty, or abnormal coron ary angiographic findings. Multivariate logistic regression analysis was us ed to assess the relationship of conventional factors and proposed uremic f actors to the presence of CAD. CAD was present in 38% of patients. Of the t otal cohort, 17% had a history of myocardial infarction and 23% had angina. Several conventional risk factors, including advancing age, male gender, d iabetes mellitus, and smoking, were significantly associated with CAD. Of t he proposed uremic factors, lower serum albumin levels but higher residual renal function and higher hematocrit values were significantly associated w ith the presence of CAD. Vascular comorbid conditions, structural cardiac a bnormalities, white race, and geographic location were also strongly correl ated with the presence of CAD. This national study suggests that several co nventional CAD risk factors may also be risk factors for CAD among the ESRD population. This study identifies nonconventional factors such as serum al bumin levels, vascular comorbid conditions, and structural cardiac abnormal ities as important disease correlates. Future longitudinal studies are requ ired to explore the relative importance of the relationships observed here.