Assessing cardiovascular disease in the dialysis patient.

Cardiac causes account for nearly half of all deaths in patients with end-stage renal disease (ESRD). Coronary artery disease (CAD) is present in 38% - 40% of patients starting dialysis. Both traditional and chronic kidney disease-related cardiovascular risk factors contribute to this high prevalence rate. In patients with ESRD, CAD--particularly acute myocardial infarction--is underdiagnosed. Dobutamine stress echocardiography and, to a lesser extent, stress myocardial perfusion imaging have proved useful in screening for CAD in such patients. Coronary artery calcium scoring is less useful. Acute myocardial infarction is associated with high short- and long-term mortality in dialysis patients. Cardiac troponin I appears to be more specific than cardiac troponin T or CK-MB in the diagnosis of acute myocardial infarction.