Background/Aims: A significant number of uremic patients develop ischemic heart disease before hemodialysis (HD) is initiated. Recently, chronic cardiorenal syndrome among predialysis patients has been recognized. However, little is known about prognostic factors in this subgroup of incident HD patients. Methods: A total of 87 incident HD patients, who were classified into cardiorenal syndrome type 4 (chronic cardiorenal syndrome), were identified at Mitsui Memorial Hospital between 1984 and 2003. The survival and risk factors for mortality were examined. Results: 25 patients died and the 5-year survival rate amounted to approximately 75%. Both all-cause mortality and the adjusted mortality for age and sex were higher in patients with a lower serum albumin level (p = 0.03) or higher serum C-reactive protein level (p = 0.02). Conclusion: The poor survival rate of incident HD patients with a medical history of ischemic heart disease was predicted by malnutrition and inflammation at the start of HD.

1.
Davenport A, Anker SD, Mebazaa A, Palazzuoli A, Bescovo G, Bellomo R, Ponikowski P, Anand I, Aspromonte N, Bagshaw S, Berl T, Bobek I, Cruz DN, Daliento L, Haapio M, Hillege H, House A, Katz N, Maisel A, Mankad S, McCullough P, Ronco F, Shaw A, Sheinfeld G, Soni S, Zamperetti N, Zanco P, Ronco C: Acute Dialysis Quality Initiative (ADQI) consensus group. ADQI 7: the clinical management of the cardio-renal syndromes: work group statements from the 7th ADQI consensus conference. Nephrol Dial Transplant 2010;25:2077–2089.
2.
Joki N, Hase H, Nakamura R, Yamguchi T: Onset of coronary artery disease prior to initiation of haemodialysis in patients with end-stage renal disease. Nephrol Dial Transplant 1997;12:718–723.
3.
Ohtake T, Kobayashi S, Moriya H, Negishi K, Okamoto K, Maesato K, Saito S: High prevalence of occult coronary artery stenosis in patients with chronic kidney disease at the initiation of renal replacement therapy: an angiographic examination. J Am Soc Nephrol 2005;16:1141–1148.
4.
Tanaka Y, Joki N, Hase H: History of acute coronary events during the predialysis phase of chronic kidney disease is a strong risk factor for major adverse cardiac events in patients initiating haemodialysis. Nephrol Dial Transplant 2007;22:2917–2923.
5.
Libby P, Ridker PM, Hansson GK, Leducq Transatlantic Network on Atherothrombosis: Inflammation in atherosclerosis: from pathophysiology to practice. J Am Coll Cardiol 2009;54:2129–2138.
6.
Libby P, Ridker PM: Inflammation and atherosclerosis: role of C-reactive protein in risk assessment. Am J Med 2004;116(suppl):9S–16S.
7.
Lin PT, Cheng CH, Liaw YP, Lee TW, Huang YC: Low pyridoxal 5′-phosphate is associated with increased risk of coronary artery disease. Nutrition 2006;22:1146–1151.
8.
Kalantar-Zadeh K, Kopple JD: Relative contributions of nutrition and inflammation to clinical outcome in dialysis patients. Am J Kidney Dis 2001;38:1343–1350.
9.
Stenvinkel P: Inflammatory and atherosclerotic interactions in the depleted uremic patient. Blood Purif 2001;19:53–61.
10.
Ronco C, McCullough P, Anker SD, Anand I, Aspromonte N, Bagshaw SM, Bellomo R, Berl T, Bobek I, Cruz DN, Daliento L, Davenport A, Haapio M, Hillege H, House AA, Katz N, Maisel A, Mankad S, Zanco P, Mebazaa A, Palzzuoli A, Ronco F, Shaw A, Sheinfeld G, Soni S, Vescovo G, Zamperetti N, Ponikowski P, Acute Dialysis Quality Initiative (ADQI) consensus group: Cardio-renal syndromes: report from the consensus conference of the ADQI. Eur Heart J 2010;31:703–711.
11.
Matsuo S, Imai E, Horio M, Tomita K, Nitta K, Yamagata K, Tomino Y, Yokoyama H, Hishida A; Collaborators developing the Japanese equation for estimated GFR. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis 2009;53:982–992.
12.
Nakai S, Masakane I, Shigematsu T, Hamano T, Yamagata K, Watanabe Y, Itami N, Ogata S, Kimata N, Shinoda T, Syouji T, Suzuki K, Taniguchi M, Tsuchida K, Nakamoto H, Nishi H, Hashimoto S, Hasegawa T, Hanafusa N, Fujii N, Marubayashi S, Morita O, Wakai K, Wada A, Iseki K, Tsubakihara Y: An overview of regular dialysis treatment in Japan (as of 31 December 2007). Ther Apher Dial 2009;13:457–504.
13.
Owen WF Jr, Lew NL, Liu Y, Lowrie EG, Lazarus JM: The urea reduction ratio and serum albumin concentration as predictors of mortality in patients undergoing hemodialysis. N Engl J Med 1993;329:1001–1006.
14.
Beddhu S, Kaysen GA, Yan G, Sarnak M, Agodoa L, Ornt D, Cheung AK, HEMO Study Group: Association of serum albumin and atherosclerosis in chronic hemodialysis patients. Am J Kidney Dis 2002;40:721–727.
15.
Liu Y, Coresh J, Eustace JA, Longenecker JC, Jaar B, Fink NE, Tracy RP, Powe NR, Klag MJ: Association between cholesterol level and mortality in dialysis patients: role of inflammation and malnutrition. JAMA 2004;291:451–459.
16.
Foley RN, Parfrey PA, Harnett JD, Kent GM, Murray DC, Barre PE: Hypoalbuminemia, cardiac morbidity, and mortality in end-stage renal disease. J Am Soc Nephrol 1996;7:728–736.
17.
Kalantar-Zadeh K, Kilpatrick RD, Kuwae N, McAllister CJ, Alcorn H Jr, Kopple JD, Greenland S: Revisiting mortality predictability of serum albumin in the dialysis population: time dependency, longitudinal changes and population-attributable fraction. Nephrol Dial Transplant 2005;20:1880–1888.
18.
Joki N, Hase H, Tanaka Y, Takahashi Y, Saijyo T, Ishikawa H, Inishi Y, Imamura Y, Hara H, Tsunoda T, Nakamura M: Relationship between serum albumin level before initiating haemodialysis and angiographic severity of coronary atherosclerosis in end-stage renal disease patients. Nephrol Dial Transplant 2006;21:1633–1639.
19.
Mimura I, Nishi H, Mise N, Mori M, Sugimoto T: Left ventricular geometry and cardiovascular mortality based on hemodialysis patient autopsy analyses. Nephrology. 2010;15:549–554.
20.
Mimura I, Kawarazaki H, Momose T, Shibagaki Y, Fujita T: Improvement of cardiac function after kidney transplantation with dilated cardiomyopathy and long dialysis vintage. Nephrol Dial Transplant Plus 2009;2:479–481.
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