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Angiographical severity of coronary atherosclerosis predicts death in the first year of hemodialysis

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Abstract

Background: Cardiac deaths andevents tend to cluster within the early-phaseafter starting dialysis. Our goal is toclarify the influence of severity of coronaryatherosclerosis on early-phase death afterstarting hemodialysis (HD) therapy. Patients and Methods: Eighty-threeconsecutive patients [mean age 62 years;male/female 64/19; diabetic nephropathy in 50(54%)] with end-stage renal disease whoadmitted to our hospital to initiate regular HDtreatment, and then received coronaryangiography within 3 months after firstdialysis therapy, were eligible for this study. Angiographical severity of coronaryatherosclerosis was scored by numerically usingGensini scoring system. The patients who diedwithin one year from starting HD were comparedwith those who survived as control by means oflogistic regression analysis.Results: Of 83 patients, 12 (14%) died lessthan one year after starting dialysis therapy. Of these 12 patients, nine died for cardiaccauses. Confirmed predictors of death fromcardiac cause were older age (>70 years),lower mean blood pressure (<100 mmHg),presence of ischemic heart disease (IHD),myocardial infarction (MI), angina pectoris(AP), chronic heart failure (CHF), poor cardiacfunction, abnormal wall motion of leftventricule (LV) and angiographical severity ofcoronary atherosclerosis by univariate model. Adjusting for confounding variables bymultivariate model, only severity of coronaryatherosclerosis (Gensini score >40 points)had a powerful influence, increasing risk forcardiac cause of early-phase death by about 17times. Conclusions: Severity ofcoronary atherosclerosis predicts death in thefirst year of HD. These findings suggest thatthe strategy for prevention of coronaryatherosclerosis should be instituted during theearly phase of chronic renal failure.

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Authors and Affiliations

  1. Third Department of Internal Medicine, TOHO University Ohashi Hospital, Tokyo, Japan

    Hiroki Hase, Yasunori Takahashi, Hiroyasu Ishikawa, Ryoichi Nakamura, Yuri Tanaka, Tomokatsu Saijyo, Masayuki Fukazawa, Yoji Inishi & Masato Nakamura

  2. Division of Dialysis, Nissan Tamagawa Hospital, Tokyo, Japan

    Nobuhiko Joki & Yoshihiko Imamura

  3. Division of Dialysis, Nissan Tamagawa Hospital, 4-8-1, Seta, Setagaya-ku, Tokyo, 158-0095, Japan; Phone

    Tetsu Yamaguchi (President of Toranomon Hospital)

Authors
  1. Nobuhiko Joki
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  2. Hiroki Hase
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  3. Yasunori Takahashi
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  4. Hiroyasu Ishikawa
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  5. Ryoichi Nakamura
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  7. Yuri Tanaka
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  8. Tomokatsu Saijyo
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  9. Masayuki Fukazawa
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  11. Masato Nakamura
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  12. Tetsu Yamaguchi
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Correspondence to Nobuhiko Joki.

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Joki, N., Hase, H., Takahashi, Y. et al. Angiographical severity of coronary atherosclerosis predicts death in the first year of hemodialysis. Int Urol Nephrol 35, 289–297 (2003). https://doi.org/10.1023/B:UROL.0000020356.82724.37

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  • DOI: https://doi.org/10.1023/B:UROL.0000020356.82724.37

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