title: Angiographical severity of coronary atherosclerosis predicts death in the first year of hemodialysis.
abstract: BACKGROUND
  Cardiac deaths and events tend to cluster within the early-phase after starting dialysis. Our goal is to clarify the influence of severity of coronary atherosclerosis on early-phase death after starting hemodialysis (HD) therapy.
  
  
  METHODS
  Eighty-three consecutive patients [mean age 62 years; male/female 64/19; diabetic nephropathy in 50 (54%)] with end-stage renal disease who admitted to our hospital to initiate regular HD treatment, and then received coronary angiography within 3 months after first dialysis therapy, were eligible for this study. Angiographical severity of coronary atherosclerosis was scored by numerically using Gensini scoring system. The patients who died within one year from starting HD were compared with those who survived as control by means of logistic regression analysis.
  
  
  RESULTS
  Of 83 patients, 12 (14%) died less than one year after starting dialysis therapy. Of these 12 patients, nine died for cardiac causes. Confirmed predictors of death from cardiac cause were older age (>70 years), lower mean blood pressure (<100 mmHg), presence of ischemic heart disease (IHD), myocardial infarction (MI), angina pectoris (AP), chronic heart failure (CHF), poor cardiac function, abnormal wall motion of left ventricule (LV) and angiographical severity of coronary atherosclerosis by univariate model. Adjusting for confounding variables by multivariate model, only severity of coronary atherosclerosis (Gensini score >40 points) had a powerful influence, increasing risk for cardiac cause of early-phase death by about 17 times.
  
  
  CONCLUSIONS
  Severity of coronary atherosclerosis predicts death in the first year of HD. These findings suggest that the strategy for prevention of coronary atherosclerosis should be instituted during the early phase of chronic renal failure.
authors.affiliation: Third Department of Internal Medicine, TOHO University Ohashi Hospital, Tokyo, Japan. joki@oha.toho-u.ac.jp
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Joki
authors.forename: Hiroki
authors.initials: H
authors.lastname: Hase
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Ishikawa
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Nakamura
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Imamura
authors.forename: Yuri
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Tomokatsu
authors.initials: T
authors.lastname: Saijyo
authors.forename: Masayuki
authors.initials: M
authors.lastname: Fukazawa
authors.forename: Yoji
authors.initials: Y
authors.lastname: Inishi
authors.forename: Masato
authors.initials: M
authors.lastname: Nakamura
authors.forename: Tetsu
authors.initials: T
authors.lastname: Yamaguchi
mesh_terms: D000328:Adult; D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D006435:Renal Dialysis; D012720:Severity of Illness Index; D013997:Time Factors