The assessment of coronary artery disease in patients with end-stage renal disease.pdf (610.03 kB)
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The assessment of coronary artery disease in patients with end-stage renal disease.

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journal contribution
posted on 17.10.2019, 09:04 by Federica E. Poli, Gaurav S. Gulsin, Gerry P. McCann, James O. Burton, Matthew P. Graham-Brown
Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality among patients with end-stage renal disease (ESRD). Clustering of traditional atherosclerotic and non-traditional risk factors drive the excess rates of coronary and non-coronary CVD in patients with ESRD. Coronary artery disease (CAD) is a key disease process, present in ∼50% of the haemodialysis population ≥65 years of age. Patients with ESRD are more likely to be asymptomatic, posing a challenge to the correct identification of CAD, which is essential for appropriate risk stratification and management. Given the lack of randomized clinical trial evidence in this population, current practice is informed by observational data with a significant potential for bias. For this reason, the most appropriate approach to the investigation of CAD is the subject of considerable discussion, with practice patterns largely varying between different centres. Traditional imaging modalities are limited in their diagnostic accuracy and prognostic value for cardiac events and survival in patients with ESRD, demonstrated by the large number of adverse cardiac outcomes among patients with negative test results. This review focuses on the current understanding of CAD screening in the ESRD population, discussing the available evidence for the use of various imaging techniques to refine risk prediction, with an emphasis on their strengths and limitations.

Funding

F.E.P. received a Wolfson Intercalated Award administered by the Royal College of Physicians and a Kidney Research UK Intercalated Degree Award. G.S.G. is a Doctoral Research Fellow funded by the British Heart Foundation. G.P.M. is funded by an NIHR Research Professorship. M.P.G.-B. is an NIHR-funded Clinical Lecturer.

History

Citation

Clinical Kidney Journal, 2019, 12 (5), pp. 721-734

Author affiliation

/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Department of Infection, Immunity and Inflammation

Version

VoR (Version of Record)

Published in

Clinical Kidney Journal

Publisher

Oxford University Press (OUP) for European Renal Association - European Dialysis and Transplant Association (ERA-EDTA)

issn

2048-8505

Acceptance date

15/06/2019

Copyright date

2019

Available date

17/10/2019

Publisher version

https://academic.oup.com/ckj/article/12/5/721/5549875

Language

en