Abstract
Guidelines have recommended that physicians screen for coronary artery disease (CAD) at the initiation of dialysis. The purpose of this study was to examine the effects of CAD screening at the initiation of dialysis on prognosis after starting dialysis This retrospective cohort study involved 224 consecutive incident dialysis patients without advanced cardiac disease. Pharmacological stress myocardial perfusion imaging (MPI) was performed to routinely screen incident dialysis patients within 3 months of starting dialysis therapy. The influence of MPI on prognosis after starting dialysis was explored by the propensity score adjustment method. The study outcome was defined as all-cause mortality and cardiac death. Of the 224 patients, 164 (73.2 %) underwent MPI screening at initiation of dialysis. During the median follow-up period of 5.5 years, 77 patients died, among whom 17 (22.1 %) cardiac deaths were observed. The patients who received MPI had a significantly higher survival rate for all-cause mortality and cardiac death compared with the patients without MPI (log-rank test, p < 0.001, p = 0.021, respectively). In multiple Cox regression analysis, MPI screening continued to have a statistically significant negative association with all-cause mortality after adjusting for confounding variables (hazard ratio 0.581, p = 0.034) and propensity score (hazard ratio 0.568, p = 0.025). MPI CAD screening at dialysis initiation could improve prognosis after starting dialysis.
Highlights
Guidelines have recommended that physicians screen for coronary artery disease (CAD) at the initiation of dialysis
Our hypothesis for the present study was that screening for CAD at the initiation of dialysis by using myocardial perfusion imaging (MPI) may lead to improved prognosis after starting dialysis
Baseline characteristics Of the 224 study patients, 164 (73.2 %) patients underwent MPI screening at the initiation of dialysis (Table 1)
Summary
Guidelines have recommended that physicians screen for coronary artery disease (CAD) at the initiation of dialysis. The purpose of this study was to examine the effects of CAD screening at the initiation of dialysis on prognosis after starting dialysis. The accelerated progression of atherosclerosis during the conservative phase of CKD, before starting dialysis therapy [5], is thought to be one of the causes of the high incidence of cardiovascular events in the dialysis phase [6, 7] Our hypothesis for the present study was that screening for CAD at the initiation of dialysis by using MPI may lead to improved prognosis after starting dialysis. This study examined the effect of MPI screening for CAD on the prognosis of incident dialysis patients
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