Coronary artery disease screening and prognosis in incident dialysis patients. Issue 1 (December 2016)

• Record Type: Journal Article
• Authors: Tanaka, Yuri; Joki, Nobuhiko; Hayashi, Toshihide; Iwasaki, Masaki; Kubo, Shun; Asakawa, Takasuke; Matsukane, Ai; Horie, Mari; Takahashi, Yasunori; Niikura, Hiroki; Hirahata, Koichi; Imamura, Yoshihiko; Hase, Hiroki
• Is Part Of: Renal replacement therapy. Volume 2:Issue 1(2016)
• Page Start: 1
• Page End: 9
• Publication Date: 2016-12
• Subjects: Myocardial perfusion imaging -- Propensity score -- Initiation of dialysis -- All-cause mortality -- Cardiac death; Kidneys -- Diseases -- Periodicals; Acute renal failure -- Treatment -- Periodicals; Kidneys -- Transplantation -- Periodicals; Hemodialysis -- Periodicals; 616.61406
• DOI: 10.1186/s41100-016-0033-3
• Languages: English
• ISSNs: 2059-1381

Abstract

Abstract Background Guidelines have recommended that physicians screen for coronary artery disease (CAD) at the initiation of dialysis. The purpose of this study was to examine the effects of CAD screening at the initiation of dialysis on prognosis after starting dialysis Methods This retrospective cohort study involved 224 consecutive incident dialysis patients without advanced cardiac disease. Pharmacological stress myocardial perfusion imaging (MPI) was performed to routinely screen incident dialysis patients within 3 months of starting dialysis therapy. The influence of MPI on prognosis after starting dialysis was explored by the propensity score adjustment method. The study outcome was defined as all-cause mortality and cardiac death. Results Of the 224 patients, 164 (73.2 %) underwent MPI screening at initiation of dialysis. During the median follow-up period of 5.5 years, 77 patients died, among whom 17 (22.1 %) cardiac deaths were observed. The patients who received MPI had a significantly higher survival rate for all-cause mortality and cardiac death compared with the patients without MPI (log-rank test, p < 0.001, p = 0.021, respectively). In multiple Cox regression analysis, MPI screening continued to have a statistically significant negative association with all-cause mortality after adjusting for confounding variables (hazard ratio 0.581, p = 0.034) and propensity score (hazard ratio 0.568, p = 0.025). Conclusions MPI CAD screening at dialysis initiation could improve prognosis after starting dialysis.