| [ Summary ] |
The cardiovascular disease (CVD) is the leading cause of death in patients receiring dialysis (ESRD). Among the types of CVD's, coronary artery disease (CAD) has become more prevalent in patients on dialysis because they as a group have become older and more often diabetic. So it is important to find earlier, means of treating and preventing CAD, even starting in the pre-dialysis phase. Coronary atherosclerotic lesions associated with ESRD are diffuse and heavily calcified. These characteristics make interventions more difficult. The symptmatology of CAD in ESRD is also very important. Chest pain is sometimes atypical (dyspnea) or completely absent (silent ischemia). To diagnose CAD and follow up, stress ECGs and scintigraphy are useful. Medical treatment and prevention of CAD are important revasculization with PCI or CABG may improve the prognosis and QOL for ESRD patients. However the limitations of these procedures should be noted: high rates of restenosis in PCI cases and in-hospital mortality for CABG cases. The prognosis for AMI in ESRD is dismal. Early diagnosis and intervention are very important. For treatment of CAD in patients with dialysis, the nephrologist, cardiologist and cardiac surgeon should cooperate and pursue the best means of treatment. |