Accelerated atherosclerosis in long-term dialysis and renal-transplant patients: fact or fiction?

The causes of death and morbidity in a series of 104 patients with end-stage renal disease were analysed in an attempt to determine whether dialysis and renal transplantation accelerate atherogenesis. Only 4 of 37 deaths were due to myocardial infarction; a further 2 were due to other manifestations of occlusive arterial disease; and severe atheroma was an incidental finding at necropsy in only 3 other patients. Symptomatic arterial disease developed during treatment in only 3 of 61 patients at present alive; 2 other patients with myocardial infarctions before dialysis treatment have survived uneventfully for long periods. These data suggest that dialysis and transplantation may allow previously acquired atherosclerosis to manifest itself clinically; but the hypothesis that atheroma is accelerated is not yet proven.