Coronary Angiography Profile at the Time of Hemodialysis Initiation in End-Stage Renal Disease Population: A Retrospective Analysis

Cardiovascular disease is associated with increased mortality in dialysis population. However, there are very few studies that assessed the prevalence of coronary artery disease (CAD) at the time of initiation of hemodialysis (HD). The present study was aimed to assess the prevalence of CAD in end-stage renal disease (ESRD) patients at the time of initiation of HD and the risk factors for CAD in this population. This was a single-center retrospective study and included ESRD patients who underwent coronary angiography (CAG) at the time of initiation of HD. Inclusion criteria were age >18 years and those who were subjected to CAG within 2 weeks of initiation of HD. According to the findings on CAG, patients were divided into no CAD and CAD groups. CAD was diagnosed if there was >50% stenosis of vessel. Clinical and laboratory parameters between these two groups were analyzed. Ninety-seven patients were included in the study based on the inclusion criteria. Forty-four (45%) patients were diagnosed with CAD. Patients who had CAD were younger compared to no CAD group (50.7 + 10 vs. 55.8 + 9.3 years; P = 0.01). Majority of them were males. Diabetic nephropathy (DN) was associated with increased risk of CAD (60% vs. 40%, P = 0.007). History of smoking, high high-sensitivity C-reactive protein (hs-CRP), low total cholesterol, and low high-density lipoprotein (HDL) were associated with significantly increased risk of CAD. Gender, symptoms of CAD, serum low-density lipoprotein (LDL), very LDL, and triglycerides were not associated with increased risk of CAD. Neither calcium (Ca), phosphorus (PO(4)), nor Ca × PO(4)products were associated with an increased risk of CAD. Resting electrocardiogram abnormalities had no significance in predicting CAD (32% in CAD and 19% in no CAD group). Echocardiography showed regional wall motion abnormalities/global hypokinesia in 18% patients of CAD group and 3.8% patients of no CAD group (P = 0.03). Single-, double-, and triple-vessel disease was documented in 17 (38%), 13 (29.5%), and 14 (32.5%) patients, respectively, and the most common vessel involved was the left anterior descending artery. At the initiation of HD in ESRD patients, CAD was seen in almost half of the patients. DN was a significant risk factor for CAD. Other risk factors for CAD include smoking, low cholesterol, low HDL, and high hs-CRP levels.