Incidence and risk factors of coronary heart disease in elderly patients on chronic hemodialysis.

ABSTRACT

AIM: To determine the incidence of coronary heart disease (CHD) in patients (pts) over 65 years (y) and its relation to common risk factors. METHODS: We retrospectively studied 128 hemodialysis (HD) pts (80 M and 48 F), mean age 73+/-6.5 years, mean time on HD 44.4+/-26.4 months and BMI 25.4+/-3 kg/m2. They were evaluated for age, sex, smoking, diabetes, hypertension, left ventricular hypertrophy, secondary hyperparathyroidism (SHP), inflammation, as evidence by elevated level of hsCRP, hyperhomocysteinemia (HOC), time on HD, fluid overload and adequacy of HD. Forty-eight pts (37%) had CAD diagnosed by coronary angiography in 22 (46%) and (201)TL-chloride dipyridamole stress test in 26 (54%). RESULTS: There was a statistically significant correlation between CAD and increasing age (p<0.0001). The relative risk was significantly increased concerning (1) male over female pts (RR 1.95, p<0.01), (2) diabetic vs. non diabetic pts (RR 2.09, p<0.001), (3) patients with SHP over pts with iPTH values<250 pg/ml (RR 2.16, p<0.001), (4) hypertensive vs. non hypertensive pts (RR 2.26, p=0.002), (5) smokers vs. non smokers (RR 1.69, p<0.05), (6) pts with HOC over pts with normal homocysteine values (RR 2.09, p<0.05), (7) pts with increased CRP levels over pts with normal CRP levels (RR 1.8, p<0.01), (8) pts undergoing HD for 36 vs. 12 months (RR 1.71, p=0.03), (9) between pts with inadequate or adequate HD (RR 1.73, p=0.02). No significant correlation existed between CAD incidence and the other risk factors. CONCLUSIONS: Coronary heart disease incidence in elderly HD patients increases with age, male sex, diabetes, SHP, hypertension, increased CRP levels, HOC, smoking, time on HD and inadequacy of HD.