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Risk factors and epidemiology of coronary heart disease in end-stage renal disease (dialysis)

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

INTRODUCTION

The presence of cardiovascular disease is an important predictor of mortality in patients with end-stage renal disease (ESRD) as it accounts for almost 50 percent of deaths [1]. Of these, approximately 20 percent can be attributed to the consequences of coronary heart disease (CHD). Patients with varying degrees of chronic kidney dysfunction but who are not yet dialysis dependent also have a markedly increased risk of morbidity and mortality from cardiovascular disease, including CHD. (See "Patient survival and maintenance dialysis" and "Chronic kidney disease and coronary heart disease".)

However, the relative prevalence of the various types of cardiac disease differs in dialysis patients compared with the general population. As an example, the single, largest, specific cause of death is attributed to arrhythmic mechanisms or sudden cardiac arrest, accounting for approximately 60 percent of all cardiac deaths. Nevertheless, the rate of death from myocardial infarction and the incidence of CHD are increased among dialysis patients versus those without kidney disease. (See "Evaluation of sudden cardiac arrest and sudden cardiac death in dialysis patients".)

This topic review will address the risk factors and epidemiology of CHD in dialysis patients. The clinical manifestations, prevention, and treatment of CHD in these patients are presented separately. (See "Clinical manifestations and diagnosis of coronary heart disease in end-stage renal disease (dialysis)" and "Secondary prevention of cardiovascular disease in end-stage renal disease (dialysis)" and "Treatment of coronary heart disease in end-stage renal disease (dialysis)".)

RISK FACTORS

Traditional risk factors — The difference in cardiovascular prognosis in dialysis patients compared with those without renal disease is related in part to the clinical status of patients when they are started on dialysis [1-4]. Based upon the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) study, a large percentage of incident dialysis patients have traditional risk factors for cardiovascular disease [3]. This includes diabetes (54 percent), low serum high-density lipoprotein (HDL) cholesterol (33 percent), hypertension (96 percent), left ventricular hypertrophy by electrocardiographic criteria (22 percent), low physical activity (80 percent), and increased age.

Many dialysis patients have more than one of these risk factors, resulting in an even higher risk of adverse outcomes [5]. (See "Hypertension in dialysis patients".)

      

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Literature review current through: Nov 2016. | This topic last updated: Tue Aug 16 00:00:00 GMT+00:00 2016.
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