Angiographical severity of coronary atherosclerosis predicts death in the first year of hemodialysis.
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.
Joki
Nobuhiko
N
Third Department of Internal Medicine, TOHO University Ohashi Hospital, Tokyo, Japan. joki@oha.toho-u.ac.jp
Hase
Hiroki
H
Takahashi
Yasunori
Y
Ishikawa
Hiroyasu
H
Nakamura
Ryoichi
R
Imamura
Yoshihiko
Y
Tanaka
Yuri
Y
Saijyo
Tomokatsu
T
Fukazawa
Masayuki
M
Inishi
Yoji
Y
Nakamura
Masato
M
Yamaguchi
Tetsu
T
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