Onset of coronary artery disease prior to initiation of dialysis

Abstract

It is known that cardiac mortality is high in the first year of dialysis. Uraemia may promote the development of atherosclerosis early in the progression of chronic renal failure. The aim of the study was to determine whether the onset of coronary artery disease precedes the initiation of dialysis in patients with end stage renal disease (ESRD). Eight-nine patients (43 with ESRD and 46 without ESRD) underwent myocardial perfusion scintigraphy (MPS) with 99mTc tetrofosmin. The patients in both groups had similar risk factors. The patients were stressed pharmacologically using adenosine. Thirty-three of 43 (76%) renal and 21/46 (45%) non-renal patients had abnormal scans. In the renal patients 13 (40%) had reversible abnormality, 16 (49%) had non-reversible defects and 4 (12%) had small vessel disease. In the non-renal group 14 (66%) patients had reversible abnormality and 7 (34%) patients had non-reversible defects. The renal patients have a relative risk of 1.7 for a positive MPS before initiation of dialysis. MPS should be performed at the initiation of dialysis, as many patients with ESRD have coronary artery disease prior to start of dialysis. Earlier intervention may offer an opportunity to reduce the burden of illness in renal failure patients.