The Prevalence of Coronary Artery Disease in Patients with End Stage Renal Disease at the Initiation of Dialysis and the Accuracy of Noninvasive Tests / 대한신장학회지

ABSTRACT

PURPOSE: Coronary artery disease (CAD) is a major cause of mortality in chronic dialysis patients, and often occurs within the first year of dialysis. However, there is little evidence based on prospective trials in incident dialysis patients, and nobody knows which noninvasive test is best for screening the CAD in these patients. Therefore, we conducted this study to examine the prevalence of CAD and the accuracy of noninvasive tests that we can easil do for detection of CAD in incident dialysis patients. METHODS: We evaluated the prevalence of CAD using resting ECG, 2D echocardiography, 99m Tc tetrofosmin single photon emission computed tomography(SPECT) and the accuracy of these non-invasive screening tests in all 84 incident dialysis patients from March 2005 to September 2006 at the Hallym University SH Hospital in Korea. RESULTS: Of eighty-four patients, 23 (27.4%) had significant CAD. Fifteen (18.9%) patients had ischemic ECG change, and its positive predictive value and sensitivity were 66.7% and 45.0%, respectively. Resting 2D echocardiography had positive predictive value of 77.3%, sensitivity of 63.6% and lower specificity of 50.0%. 99m Tc tetrofosmin SPECT had positive predictive value of 73.3% and sensitivity of 73.3%. CONCLUSION: The prevalence of CAD in patients at the initiation of dialysis was 27.4%. 99m Tc tetrofosmin SPECT may be helpful for diagnosing CAD with ECG and 2D-echocardiography because of high sensitivity and positive predictive value.