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Clinical manifestations and diagnosis of coronary heart disease in end-stage renal disease (dialysis)

Alfred K Cheung, MD
William L Henrich, MD, MACP
Charles A Herzog, MD
Section Editors
Jeffrey S Berns, MD
Steve J Schwab, MD
Bernard J Gersh, MB, ChB, DPhil, FRCP, MACC
Deputy Editor
Alice M Sheridan, MD


Cardiovascular disease (CVD) accounts for almost half the deaths of patients with end-stage renal disease (ESRD) [1-4]. Of these, approximately 20 percent can be attributed to coronary artery disease (CAD), also referred to as coronary heart disease (CHD). Patients with varying stages of chronic kidney disease (CKD), but who are not yet dialysis dependent, also have a markedly increased risk of morbidity and mortality from CVD, including CHD. (See "Patient survival and maintenance dialysis" and "Chronic kidney disease and coronary heart disease".)

This topic reviews screening, clinical manifestations, and diagnosis of stable CHD and acute coronary syndrome in ESRD patients. CHD in the general population is discussed elsewhere. (See "Coronary heart disease and myocardial infarction in young men and women" and "Screening for coronary heart disease".)

Other aspects of CHD in dialysis patients are presented elsewhere. (See "Secondary prevention of cardiovascular disease in end-stage renal disease (dialysis)" and "Risk factors and epidemiology of coronary heart disease in end-stage renal disease (dialysis)".)


Many of the issues concerning the presentation and evaluation of the stable ESRD patient suspected of having CHD are the same in those in the general population. (See "Screening for coronary heart disease" and "Coronary heart disease and myocardial infarction in young men and women", section on 'Clinical presentation' and "Clinical features and diagnosis of coronary heart disease in women", section on 'Clinical presentation'.)

The following sections will specifically address issues unique to dialysis patients. However, as noted in the following sections, very few randomized trials have been performed in these individuals.

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Literature review current through: Dec 2017. | This topic last updated: Sep 06, 2017.
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