Combined assessment of cardiac systolic dysfunction and coronary atherosclerosis used to predict future cardiac deaths after starting hemodialysis.
OBJECTIVE
Identification of end-stage renal disease (ESRD) patients at high risk for cardiac events is important for clinical dialysis management. The present study determined whether the combination of cardiac function and coronary atherosclerosis could predict future cardiac events after starting renal replacement therapy (RRT).


METHODS
We prospectively assessed left ventricle ejection fraction (EF) and Gensini score (GS) using angiographic severity of coronary atherosclerosis in 88 consecutive ESRD patients [mean age 62 years; 69 males (78%); 55 patients (64%) with diabetic nephropathy] at the initiation of RRT. EF was analyzed by echocardiogram, and GS was scored by coronary angiography within 3 months after starting RRT. The study end point was cardiac death. For analysis of the association between cardiac death and EF and GS measures, the univariate and multivariate Cox proportional hazards model was used. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value, and accuracy of event-free prediction were evaluated.


RESULTS
Twenty-four patients (27%) had low cardiac function (EF <50%; low EF) and 44 patients (50%) had severe coronary atherosclerosis (GS >15; high GS). During a follow-up period of 3 years, cardiac death occurred in 21 patients (24%). The PPV of low EF and high GS was 42 and 39%, respectively; the highest PPV (53%) was obtained when low EF and high GS were combined. The cumulative survival rate at 5 years in patients with both low EF and high GS was significantly lower than those with high EF and low GS (91 vs. 22%, p < 0.0005).


CONCLUSIONS
The combined assessment of cardiac function and coronary atherosclerosis at the initiation of RRT strongly predicts future cardiac events.
Division of Dialysis and Nephrology, Nissan Tamagawa Hospital, Tokyo, Japan. joki@oha.toho-u.ac.jp
Nobuhiko
N
Joki
Hiroki
H
Hase
Tomokatsu
T
Saijyo
Yuri
Y
Tanaka
Yasunori
Y
Takahashi
Hiroyasu
H
Ishikawa
Ryoichi
R
Nakamura
Masayuki
M
Fukazawa
Yoji
Y
Inishi
Masato
M
Nakamura
Yoshihiko
Y
Imamura
D002423:Cause of Death; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality*; D016757:Death, Sudden, Cardiac; D004452:Echocardiography; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012044:Regression Analysis; D006435:Renal Dialysis; D012307:Risk Factors; D016019:Survival Analysis; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000401:mortality*