Ischemic Heart Disease in Chronic Renal Failure: Demography, Epidemiology, and Pathogenesis

  • Stephen G. Rostand
  • Edwin A. Rutsky
Part of the Topics in Renal Medicine book series (TIRM, volume 10)


Cardiac diseases, especially ischemie heart disease, remain a leading cause of death among patients receiving renal replacement therapy with either dialysis or transplantation. Although a recent report [1] suggests that heart disease mortality in the dialysis population may have decreased during the past 15 years, this same study and another [1,2] show that all-cause cardiac mortality has not changed appreciably from that reported previously [3,4]. Thus, heart disease mortality has remained nearly constant, representing 30% to 50% of all deaths in dialysis populations, with myocardial infarction causing about 10% to 15% of all deaths [3–5]. In renal-transplant populations, myocardial infarction and ischemic heart disease occur in about 8% and 11% of patients, respectively [6]. Myocardial infarction is the second leading cause of death in this group. The fact that sustained high mortality rates from ischemie heart disease persist in the end-stage renal disease (ESRD) population is not surprising given its demographic characteristics, the high rates of nonfatal symptomatic ischemie heart disease, and the clustering within these patients of numerous disease- and treatment-associated alterations in hemodynamics, metabolism, and cardiac structure that affect myocardial performance, perfusion, and oxygenation (figure 4–1).


Nephrotic Syndrome Ischemic Heart Disease Chronic Renal Failure Dialysis Patient Coronary Blood Flow 
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© Springer Science+Business Media New York 1992

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  • Stephen G. Rostand
  • Edwin A. Rutsky

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