Among patients with advanced chronic kidney disease (CKD), cardiovascular disease (CVD) is the leading cause of death, 15 to 30 times higher than the age-adjusted cardiovascular mortality rate il the general population.
We sought to determine demographic features, cardiovascular risk factors, clinical presentation, in-hospital course and prognosis of patients on chronic hemodialysis undergoing percutaneous coronary intervention (PCI).
The study was carried out on a retrospective registry including 6544 patients undergoing PCI in the Cardiology Department of Fattouma bourguiba University Hospital (Monastir, Tunisia) between January 2014 and March 2018.
Out of the overall population, 214 patients were part of the CKD group and 71 were on chronic dialysis (1.1%) via arteriovenous fistula in 94.4% of cases. Forty-nine (69%) of them were male. Mean age was 58.9±10.9 years (33–80 years). Dialysis patients had higher prevalence of high blood pressure (81.7%) and diabetes mellitus (49.3%). Only the third of patients was hospitalized in intensive care unit and median period of hospitalization was 10 days. At admission, CKD patients presented most commonly with non ST-elevation myocardial infarction, stable angina and ST-elevation myocardial infarction respectively in 49%, 29.5% and 14%. In-hospital complications were a blend of cardiogenic shock (2 cases), new onset atrial fibrillation (5 cases), atrioventricular block (2 cases), ventricular fibrillation (1 case), heart failure (12 cases) and ischemic mitral insufficiency (5 cases). Left ventricular function was preserved among 45% of patients and left ventricular hypertrophy was noted in 55%.
Patients with CKD on chronic dialysis carry a considerable burden of CVD relative to patients with normal renal function. Initial clinical presentation was very impactful on in-hospital outcomes.
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Publié par Elsevier Masson SAS.