Incidence and risk factors of coronary heart disease in elderly patients on chronic hemodialysis

Aim: To determine the incidence of coronary heart disease (CHD) in patients (pts) over 65 years (y) and its relation to common risk factors.Methods: We retrospectively studied 128 hemodialysis (HD) pts (80 M and 48 F), mean age 73 ± 6.5 years, mean time on HD 44.4 ± 26.4 months and BMI 25.4 ± 3 kg/m2. They were evaluated for: age, sex, smoking, diabetes, hypertension, left ventricular hypertrophy, secondary hyperparathyroidism (SHP), inflammation, as evidence by elevated level of hsCRP, hyperhomocysteinemia (HOC), time on HD, fluid overload and adequacy of HD. Forty-eight pts (37%) had CAD diagnosed by coronary angiography in 22 (46%) and 201TL-chloride dipyridamole stress test in 26 (54%).Results: There was a statistically significant correlation between CAD and increasing age (p < 0.0001). The relative risk was significantly increased concerning: (1) male over female pts (RR: 1.95, p < 0.01), (2) diabetic vs. non diabetic pts (RR: 2.09, p < 0.001), (3) patients with SHP over pts with iPTH values < 250 pg/ml (RR: 2.16, p < 0.001), (4) hypertensive vs. non hypertensive pts (RR: 2.26, p = 0.002), (5) smokers vs. non smokers (RR: 1.69, p < 0.05), (6) pts with HOC over pts with normal homocysteine values (RR: 2.09, p < 0.05), (7) pts with increased CRP levels over pts with normal CRP levels (RR: 1.8, p < 0.01), (8) pts undergoing HD for 36 vs. 12 months (RR: 1.71, p = 0.03), (9) between pts with inadequate or adequate HD (RR: 1.73, p = 0.02). No significant correlation existed between CAD incidence and the other risk factors.Conclusions: Coronary heart disease incidence in elderly HD patients increases with age, male sex, diabetes, SHP, hypertension, increased CRP levels, HOC, smoking, time on HD and inadequacy of HD.