Dipyridamole stress echocardiography in diagnosis and prognosis of hemodialysis patients with asymptomatic coronary disease

The prevalence of coronary artery disease (CAD) is high in hemodialysis (HD) patients. The aim of the study was to assess the diagnostic and prognostic value of dipyridamole stress echocardiography (DSE) in nondiabetic HD patients without signs or symptoms of CAD. In 51 out of 158 evaluated HD patients (21 females, age 67 [33-85] years, HD duration 38 [9-271] months), resting echocardiography and DSE were performed. Exclusion criteria were known CAD, diabetes mellitus, and pulmonary and oncologic pathologies. Logistic regression analysis was carried out to identify predictors of abnormal DSE response, while Cox regression analysis was performed to determine variables associated with total and cardiovascular mortality, after 43.3 (11-60) months of follow-up. Seven patients (14%) showed a positive response to DSE (DSE+). In 5/7, CAD was documented by angiography: All of them underwent coronary revascularization. DSE+ patients had significantly smaller body mass index than patients with a negative response (DSE-): 21.7 ± 1.9 vs. 25.1 ± 3.4 kg/m(2) (p = 0.018). During follow-up, 16 (31%) patients died. Older age hazard ratio [HR = 1.07; confidence interval (CI) = 1.01-1.12; p = 0.02] and higher plasma phosphate levels (HR = 10.41; CI = 2.30-47.17; p < 0.01) were predictors of total mortality. Male gender (HR = 22.7; CI = 1.45-354.4; p = 0.03), older age (HR = 1.24; CI = 1.03-1.50; p = 0.02), longer HD duration (HR = 1.13; CI = 1.01-1.26; p = 0.04), and positive response to DSE (HR = 5.82; CI = 1.04-32.65; p = 0.04) were associated with cardiovascular mortality. Ten percent of asymptomatic HD patients had significant CAD, but timely diagnosis did not seem to improve their prognosis. Total survival was associated with age and higher levels of plasma phosphate, while male gender, older age, longer HD duration, and DSE+ were predictors of cardiovascular mortality.