To determine the prognosis and risk factors for ischemic heart disease in chronic
uremia, a cohort of 432 dialysis patients were followed prospectively from start of
dialysis therapy until death or renal transplantation. Baseline demographic, clinical
and echocardiographic data were obtained. After the initiation of dialysis laboratory
data were collected at monthly intervals, and clinical and echocardiographic data
at yearly intervals. Twenty-two percent of patients (N = 95) had either a history
of angina pectoris or myocardial infarction on starting dialysis therapy. Median time
to onset of heart failure was 24 months in those with ischemic heart disease on initiation
of dialysis, compared to 55 months in those without (P < 0.0001). This effect was
independent of age, diabetes and underlying cardiomyopathy. Median survival was 44
months in those with ischemic disease compared to 56 months in those without (P =
0.0001). This adverse impact was independent of age and diabetes mellitus but, when
cardiac failure was added to the Cox's model, ischemic heart disease was no longer
an independent predictor of survival. De novo ischemic heart disease, not evident
on starting dialysis therapy, occurred in 41 (9%) patients. When compared to patients
who never developed ischemic disease (N = 296; 69%), significant and independent predictors
of de novo disease were older age (P = 0.0007), diabetes mellitus (P = 0.0001), high
blood pressure during follow up on dialysis (P = 0.02) and hypoalbuminemia (P = 0.03),
whereas anemia was not an independent predictor. LV mass index was 174 +/- 7 g/m2
in those who developed de novo ischemic disease compared to 155 +/- 3 g/m2 (P < 0.001)
in those who did not. Concentric LV hypertrophy, LV dilation and systolic dysfunction
were independent risk factors for de novo ischemic heart disease. We conclude that
ischemic heart disease occurs frequently in dialysis patients, that its adverse impact
is mediated through the development of heart failure, and that the most important,
potentially reversible risk factors are hypertension, hypoalbuminemia, and underlying
cardiomyopathy.