Epicardial coronary heart disease in ckd: Diagnosis and management

Abstract

Chronic kidney disease (CKD) is an increasingly common problem, affecting approximately 10 % of the world’s population [1]. Patients with CKD are at increased risk of cardiovascular disease, and in fact, cardiac causes account for more than 50 % of deaths in CKD patients [2]. And yet, coronary artery disease remains underdiagnosed and undertreated in this population. Recognition of underlying coronary artery disease can be complicated in CKD patients because many are asymptomatic [3]. Several small studies have demonstrated obstructive coronary lesions (defined as stenosis greater than 50 % of the lumen diameter) in up to 50 % of asymptomatic patients with CKD (stages 4 and 5) [4, 5]. The paucity of symptoms may be due to a variety of factors, including neuropathy [6] and decreased exercise tolerance. In addition, subtle symptoms such as dyspnea on exertion or fatigue may be attributed to other causes, such as anemia.