title: Usefulness of multidetector row computed tomography for predicting cardiac events in asymptomatic chronic kidney disease patients at the initiation of renal replacement therapy.
abstract: BACKGROUND
  The prevalence of coronary artery stenosis (CAS) at the initiation of renal replacement therapy (RRT) in chronic kidney disease (CKD) patients has not been fully elucidated. Although coronary angiography is the gold standard in diagnosing CAS its invasiveness and economic burden lead to searching for a noninvasive alternative method. In this study, we evaluated the prevalence of CAS by multidetector row computed tomography (MDCT) and related risk factor to articulate the usefulness of MDCT.
  
  
  METHODS
  Seventy-four asymptomatic CKD patients who began dialysis were evaluated with echocardiography and MDCT. The patients were stratified into two groups according to CAS and coronary artery calcification score (CACS) by MDCT to detect silent CAS and evaluate its predictability for cardiac events.
  
  
  RESULTS
  CAS was seen in 24 (32.4%) of 74 asymptomatic CKD patients on MDCT. Both groups showed increasing frequencies of CAS with age (P < 0.01), presence of diabetes (P < 0.05), uric acid level (P < 0.01), and calcium score (P < 0.01). Multiple regression analysis revealed that age and uric acid level were independent risk factors for CAS and high CACS in asymptomatic CKD patients at the initiation of dialysis. Patients with both CAS and high CACS were presented with higher cardiac events rates compared to those without any of them. In Cox regression model, age and the presence of CAS and high CACS on MDCT were an independent risk factor for cardiac events in these patients.
  
  
  CONCLUSIONS
  We showed that CAS was highly seen in asymptomatic CKD patients starting dialysis. Moreover, both high CACS and CAS on MDCT might predict cardiac events in these patients and MDCT can be a useful screening tool for evaluating coronary artery disease and predicting cardiovascular mortality noninvasively.
authors.affiliation: Department of Internal Medicine, Yonsei University, College of Medicine, Seoul 120-752, Republic of Korea.
authors.forename: Jung Eun
authors.initials: JE
authors.lastname: Lee
authors.affiliation: Nephrology Division, Department of Internal Medicine, NHIC, Ilsan Hospital, Goyang 410-719, Republic of Korea.
authors.forename: Yong Kyu
authors.initials: YK
authors.lastname: Lee
authors.affiliation: Department of Radiology, Yonsei University, College of Medicine, Seoul 120-752, Republic of Korea.
authors.forename: Eun Jeong
authors.initials: EJ
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, Yonsei University, College of Medicine, Seoul 120-752, Republic of Korea.
authors.forename: Ji Sun
authors.initials: JS
authors.lastname: Nam
authors.affiliation: Department of Radiology, Yonsei University, College of Medicine, Seoul 120-752, Republic of Korea.
authors.forename: Byoung Wook
authors.initials: BW
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, Yonsei University, College of Medicine, Seoul 120-752, Republic of Korea ; The Research Institute for Transplantation, Yonsei University, College of Medicine, Seoul 120-752, Republic of Korea.
authors.forename: Beom Seok
authors.initials: BS
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D017582:Renal Replacement Therapy; D014057:Tomography, X-Ray Computed / Q000379:methods*