| Theme | New perspectives in the management of patients with diabetes undergoing dialysis | |
|---|---|---|
| Title | Heart disease in end stage kidney disease patients with diabetes mellitus | |
| Publish Date | 2019/01 | |
| Author | Masaki Iwasaki | Department of Nephrology (Ohashi), Toho University |
| Author | Hiroki Hase | Department of Nephrology (Ohashi), Toho University |
| [ Summary ] | An imbalance between myocardial oxygen demand and supply is attributable not only to coronary artery stenosis but also to other factors including anemia, arteriovenous fistula, left ventricular hypertrophy, and tachycardia. Anemia, and arteriovenous fistula among other such conditions can precipitate myocardial ischemia even without significant stenosis of the coronary arteries. It is difficult to diagnose ischemic heart disease (IHD) among end stage kidney disease patients with diabetes mellitus because these patients often do not present with typical symptoms. Congestion (refractory to adjustment of dry weight), intradialytic hypotension, and nocturnal paroxysmal dyspnea are findings suggestive of IHD, even if patients do not show typical chest symptoms. In patients with a suspicion of IHD, depending on the patient's condition, the examination of following in order must be performed. 1. electrocardiogram and ultrasound cardiogram 2. stress electrocardiogram and/or stress myocardial perfusion single-photon emission computed tomography 3. coronary angiography |
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