Diagnostic tools and management strategies for coronary artery disease in patients with end-stage renal disease.

Patients with renal disease often have coexistent coronary artery disease (CAD). The 5-year survival rates are < 50% and cardiovascular disease accounts for nearly half of the deaths in patients with end-stage renal disease (ESRD) on maintenance dialysis. Renal disease is often caused by hypertension or diabetes mellitus, both very strong risk factors for the development of CAD. Other patients develop hypertension after the onset of their renal disease. These coexistent diseases partially contribute to the increased incidence of CAD in the renal patient. Managing physicians must maintain a high index of suspicion and interpret the results of diagnostic studies with this high pretest probability in mind. Consideration should be given for screening for the presence of ischemic heart disease in patients with ESRD and no symptoms, especially if being considered as renal transplant recipients. It remains most important to adequately treat the associated risk factors and specifically, aggressively control the blood pressure. This report discusses the known and suspected reasons for the highly associated coexistent CAD, methods for diagnosing and risk-stratifying CAD, and renal-specific guidelines for appropriate treatment.