Cardiovascular issues of dialysis patients referred for ultrasound examination of vascular access grafts

Abstract

Aims: Patients with end-stage renal disease have high morbidity and mortality rates. The one-year mortality is 20-23%, with cardiovascular disease accounting for almost 43%. The aim of the present study was to describe cardiovascular epidemiology in patients referred for specialist ultrasound examination of their grafts. Methods: In our department, we investigate patients with grafts every 3 months after access creation. The patients come with a form completed by the nephrologist, which contains data regarding the patient's history of cardiovascular disease and their risk factors. Results: Coronary heart disease was present in 47% of patients, chronic heart failure in 17%, arterial hypertension in 77%, dyslipidemia was diagnosed in 49%, and diabetes mellitus in 54% of patients. There were 18% of smokers and 20% of ex-smokers. Beta-blockers were used by 22% of patients, ACE inhibitors by 37%, calcium channel blockers by 18%, statins by 33%, and nitrates by 9% of patients. Eighty-six percent of patients used antiplatelet therapy. Patients with coronary heart disease had significantly more often heart failure, dyslipidemia, and diabetes mellitus, and used more commonly nitrates in the medication. Patients with diabetes mellitus had more often coronary heart disease, arterial hypertension, and dyslipidemia. They were treated more often by beta-blockers, calcium channel blockers, and statins. Statins were used by 65% of the 144 patients with the diagnosis of dyslipidemia. Conclusions: Patients with end-stage renal disease on dialysis have high cardiovascular morbidity. The prevalence of chronic heart failure is likely to be underdiagnosed. There is certainly room for improvement in the treatment of these patients.