MP317NON INVASIVE DIAGNOSIS OF CORONARY ARTERY DISEASE IN A COHORT OF CHRONIC KIDNEY DISEASE DIAGNOSIS OF CORONARY ARTERY DISEASE IN A COHORT OF CHRONIC KIDNEY DISEASE

Abstract

INTRODUCTION AND AIMS: The major cause of mortality and morbidity in chronic kidney disease (CKD) is cardiovascular disease. However, the concern for contrast induced nephropathy (CIN) remains a hindrance towards coronary angiography (CAG). Hence the true prevalence of coronary artery disease (CAD) in CKD is largely unknown. The present study aims at using two non invasive methods, namely Dobutamine Stress Echocardiography (DSE) and Myocardial perfusion Imaging (MPI) to assess the coronary artery status and comparing their sensitivity with CAG, the gold standard. METHODS: 43 CKD patients who had symptomatic CAD were randomized into 2 groups, DSE (n=20) and MPI (n=23). The baseline creatinine in the two groups was comparable (2.2 mg/dl vs. 2.5 mg/dl) as was the MDRD GFR (50 ml/min vs. 55 ml/min respectively). The male: female ratios in the two arms were 1.66:1 and 1.55:1 respectively, with the mean ages in the two groups being 45 years and 48 years. Those who were positive in DSE and MPI were subjected to CAG after taking an informed consent and institutional ethics committee clearance. RESULTS: Of the 20 patients who were subjected to DSE, 15 patients had significant coronary artery stenosis (>90% stenosis). When these patients were subjected to CAG, major CAD was found in 10 (66.67%) of the 23 patients who were subjected toMPI, 13 were positive (regional hypoperfusion noted at stress), of which 10 showed major CAD (77%) on CAG. One each in the DSE arm and MPI arm who remained symptomatic despite being negative in these non invasive tests, were subjected to CAG and found to have significant CAD. The most common side effect in DSE group was rise in blood pressure and pulse rate, which could bemanaged medically. There was no significant side effect in theMPI arm. Among the patients who were subjected to CAG, 7 patients in the DSE arm and 5 patients in theMPI arm had deterioration in renal function. This was managed conservatively with fluids and N‐ acetyl cysteine. None of these patients required dialysis for the deterioration of renal function and they subsequently stabilized. CONCLUSIONS: Both the non invasive methods to assess CAD were comparable in efficacy. But DSE being cheaper in comparison to MPI is recommended as an effective means to assess CAD in CKD patients.