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Angioplasty and stenting in patients with renal disease
  1. Department of Cardiology, Necker Hospital
  2. 149 rue de Sèvres, 75015 Paris, France

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Cardiac disease remains the leading cause of mortality among patients with end stage renal disease on haemodialysis. Disappointing results have been obtained with coronary angioplasty in these patients. Few data on angioplasty and stenting are available in this high risk population.

Coronary artery disease in dialysis patients

Among all patients in the United States in whom dialysis was initiated in 1987, the five year mortality rate was 73%.1Cardiovascular disease accounted for half the total mortality,1 and myocardial infarction for half the cardiac deaths.2 The overall mortality after myocardial infarction among 34 189 patients on long term dialysis identified from the US Renal Data System database was 59% at one year and 90% at five years.3 Atherogenesis seems to be accelerated in haemodialysis patients,4 but does not seem to be secondary to the dialysis itself. Half of all dialysis patients have evidence of coronary artery disease before the initiation of haemodialysis,5 and no correlation has been found between cardiac events and the duration of dialysis.6 The high prevalence of coronary artery disease in these patients seems to be related to numerous risk factors for atherosclerosis, including lipid abnormalities, hypertension, diabetes, hypercoagulation, coronary calcification related to secondary hyperparathyroidism, and hyperhomocysteinaemia.7 …

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