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      Assessment of Coronary Artery Disease in Hemodialysis Patients with Delayed Systolic Blood Pressure Response after Exercise Testing

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          Background: We evaluated usefulness of the postexercise systolic blood pressure (SBP) response for detecting coronary artery disease (CAD) in hemodialysis patients. Methods: A treadmill exercise testing was done, and the SBP response was measured in 44 hemodialysis patients (30 men, 14 women; age 41 to 81 years). The postexercise SBP response was defined as the ratio of SBP after 3 minutes of recovery to SBP at peak exercise. Results: The SBP ratio of the 25 subjects with coronary artery stenosis (1.01 ± 0.13) was significantly greater (p <0.01) than 19 subjects without coronary artery stenosis (0.83 ± 0.10). An SBP ratio greater than 0.92 identified CAD with higher sensitivity, specificity, and accuracy than did the conventional ST-segment depression criterion (76 vs. 56%, 90 vs. 53%, and 82 vs. 55%, respectively). Conclusion: Determination of the SBP ratio is a clinically useful, noninvasive method for accurately detecting CAD in hemodialysis patients.

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          Poor long-term survival after acute myocardial infarction among patients on long-term dialysis.

          Cardiovascular disease is common in patients on long-term dialysis, and it accounts for 44 percent of overall mortality in this group. We undertook a study to assess long-term survival after acute myocardial infarction among patients in the United States who were receiving long-term dialysis. Patients on dialysis who were hospitalized during the period from 1977 to 1995 for a first myocardial infarction after the initiation of renal-replacement therapy were retrospectively identified from the U.S. Renal Data System data base. Overall mortality and mortality from cardiac causes (including all in-hospital deaths) were estimated by the life-table method. The effect of independent predictors on survival was examined in a Cox regression model with adjustment for existing illnesses. The overall mortality (+/-SE) after acute myocardial infarction among 34,189 patients on long-term dialysis was 59.3+/-0.3 percent at one year, 73.0+/-0.3 percent at two years, and 89.9+/-0.2 percent at five years. The mortality from cardiac causes was 40.8+/-0.3 percent at one year, 51.8+/-0.3 percent at two years, and 70.2+/-0.4 percent at five years. Patients who were older or had diabetes had higher mortality than patients without these characteristics. Adverse outcomes occurred even in patients who had acute myocardial infarction in 1990 through 1995. Also, the mortality rate after myocardial infarction was considerably higher for patients on long-term dialysis than for renal-transplant recipients. Patients on dialysis who have acute myocardial infarction have high mortality from cardiac causes and poor long-term survival.
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            Clinical and echocardiographic disease in patients starting end-stage renal disease therapy

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              Cardiovascular mortality in end-stage renal disease.

               V Collins (2003)
              Cardiovascular disease accounts for more than 50% of end-stage renal disease (ESRD) deaths. The reported cardiovascular death rates in patients receiving dialysis are substantially higher than in the general population. Cardiovascular mortality in ESRD is particularly high after acute myocardial infarction, but it is also elevated in ESRD patients with other forms of atherosclerotic vascular disease (eg, chronic coronary artery disease, strokes, transient ischemic attacks, and peripheral arterial disease). Left ventricular hypertrophy and dilation are associated with increased cardiovascular mortality, as is congestive heart failure. One of the major reasons for such high cardiovascular mortality in ESRD is the large burden of cardiovascular disease present in patients with chronic artery disease before renal replacement therapy. These observations mandate not only aggressive diagnosis and treatment of cardiovascular disease in patients with ESRD, but also active screening, diagnosis, and treatment in those with chronic kidney disease before renal replacement therapy.

                Author and article information

                Blood Purif
                Blood Purification
                S. Karger AG
                December 2005
                19 December 2005
                : 23
                : 6
                : 466-472
                aDepartment of Medicine II, Kansai Medical University, Osaka; bDivision of Hypertension and Nephrology, Kyoto Prefectural University of Medicine, Kyoto, and cDepartment of Cardiology, Kaiseikai Takarazuka Hospital, Hyogo, Japan
                89651 Blood Purif 2005;23:466–472
                © 2005 S. Karger AG, Basel

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                Figures: 3, Tables: 3, References: 32, Pages: 7
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