New perspectives on coronary artery disease in hemodialysis patients.
Between July 1, 1979, and July 1, 1980, we treated 64 patients with long-term maintenance hemodialysis. Of these, 11 (17%) had angina pectoris, four of them (6%) chronic stable angina and seven (11%) new onset of crescendo angina. The most common risk factors in the group with unstable angina were cardiomegaly and hypertension. Of the five patients who underwent cardiac catheterization, proximal occlusive disease was seen in four and these four had good left ventricular function. Three patients underwent coronary artery bypass, which successfully improved their functional status to a class I or II without any antianginal medicines. Concurrent hemodialysis was performed during heart-lung bypass in one patient. The need for dialysis postoperatively was easily delayed for 72 hours without detriment to this patient. We reached the following conclusions: (1) The prevalence of angina in a stable hemodialysis population was 17% in a one-year analysis period. (2) The incidence of new onset of crescendo angina, which potentially requires coronary angiography, was 11% over the same one-year period. (3) The presence of surgically correctable lesions in these cases is high. (4) Concurrent hemodialysis during coronary artery bypass simplifies postoperative fluid and electrolyte management and prevents surgical bleeding.
D000787:Angina Pectoris / Q000601:surgery; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods; D003327:Coronary Disease / Q000150:complications / Q000601:surgery*; D006801:Humans; D007430:Intraoperative Care; D007676:Kidney Failure, Chronic / Q000150:complications; D006435:Renal Dialysis