Coronary Assessment In Young Patients On Hemodialysis

Background: The usefulness of invasive coronary assessment and treatment in patients with advanced chronic kidney disease (CKD) is controversial. We hypothesized that the short life-expectance in these patients interferes with the effect of CV assessment and treatment. We explored the possibility that in younger dialysis patients with longer lifetime expectance, coronary assessment will identify individuals at higher risk of events. Methods: 1380 asymptomatic patients on hemodialysis (51.4 ± 9.3 y, 68%, Whites, 62% males, 33% smokers, 34%, dyslipidemics, 42%, diabetics, 34%, with coronary artery disease (CAD) and, 39%, with CV disease) were followed up until death or transplantation (mean= 72 ± 32 months). All patients underwent myocardial scan and coronary angiography was performed in 880. The incidence of CV events (log-rank= 0.0001) and death (log-rank= 0.0001) were increased in patients with altered myocardial scan. Patients with CAD (n= 468) had a significant increase in the risk of CV events (log-rank= 0.0001) and death (log-rank= 0.013). In patients with CAD the incidence of composite CV events was comparable between patients undergoing intervention (99) and those treated medically (369), (log-rank= 0.477) whereas intervention was associated with a reduced incidence of death by any cause (log-rank= 0.020). Conclusion: in younger asymptomatic dialysis patients coronary assessment identified individuals at higher risk of events and coronary intervention was associated with reduction in the incidence of death. This work suggests that the negative results associated with coronary assessment observed in the elderly CKD patients may not necessarily applies to younger subjects.