title: Independent risk factors for progression of coronary atherosclerosis in hemodialysis patients.
abstract: Not uncommonly, hemodialysis patients with normal results in myocardial perfusion tests can still have a cardiac event within 2 years of evaluation. We examined possible risk factors for progression of coronary atherosclerosis in hemodialysis patients. We prospectively evaluated ability of myocardial perfusion imaging carried out under pharmacologic stress to predict 2-year outcomes in 77 hemodialysis patients, specifically thallium-201 single-photon emission computed tomography (SPECT) using high-dose adenosine triphosphate as the stressor. The primary end-point was a cardiac event (cardiac death, non-fatal acute coronary syndrome, or hospitalization for acute ischemic heart failure). Factors independently influencing duration until a cardiac event in hemodialysis patients were identified using stepwise multiple regression analysis. Myocardial perfusion defects were shown in 36 patients. Patients with a perfusion defect were more likely to have cardiac events than those with normal perfusion (78% vs. 15%, P < 0.001). Time until occurrence of a cardiac event in hemodialysis patients showed a significant, independent association with known coronary artery disease [regression coefficient (RC) = -3.391, P = 0.046], elevated C-reactive protein (RC = -5.813, P = 0.005), and a reversible myocardial perfusion defect (RC = -7.386, P < 0.001). An analysis based on the 'best cut-off' of CRP as identified on the basis of the ROC curve augmented the positive and negative predict value of CRP for the prediction of coronary events to 65 and 74%, respectively. Myocardial perfusion SPECT and measuring the plasma concentration of CRP might be useful for the prediction of hemodialysis patients with progression of coronary atherosclerosis.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Toho University Ohashi Hospital, Tokyo, Japan. hiroki@oha.toho-u.ac.jp
authors.forename: Hiroki
authors.initials: H
authors.lastname: Hase
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Joki
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Ishikawa
authors.forename: Tomokatsu
authors.initials: T
authors.lastname: Saijyo
authors.forename: Yuri
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Yoji
authors.initials: Y
authors.lastname: Inishi
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Imamura
authors.forename: Masato
authors.initials: M
authors.lastname: Nakamura
authors.forename: Masao
authors.initials: M
authors.lastname: Moroi
mesh_terms: D000255:Adenosine Triphosphate / Q000009:adverse effects; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology*; D004452:Echocardiography; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000150:complications / Q000628:therapy; D012307:Risk Factors; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D013794:Thallium Radioisotopes; D000255:Adenosine Triphosphate