Abstract
The prognosis for chronic dialysis patients frequently depends on cardiovascular complications. Clinical studies on coronary sclerosis and pericardial effusion are reported here.
(A) Coronary sclerosis: Coronary artery calcification was detected by fluoroscopy in 14 of 65 hemodialyzed patients.The calcifications were divided into 11“diffuse”type and 3 “local” type. A patient with angina pectoris was one of the patients with diffuse type calcification of 3 vessels, LAD, CX and RCA. Coronary calcification was found in 4 of 7 diabetic patients, a markedly higher incidence than in patients hemodialysed because of other renal diseases.All patients with coronary calcification were more than 50 years old, and the duration of hemodialysis was more than 3 years in all patients except one.Coronary artery calcification was detected in 13 of the 20 patients more than 50 years old and the duration of hemodialysis was more than 3 years.Diffuse type calcification of 2 or 3 vessels was found in 8 of these 13 patients, in contrast to 2 of 19 undialyzed patients with chronic renal failure who were more than 50 years old.The incidence of calcification was markedly higher in the former group, even when diabetic patients were excluded.It is suggested that hemodialysis might be one of the risk factors of coronary sclerosis, and that careful management should be provided especially for the older and/or diabetic patients.
(B) Pericardial effusion: Subxiphoid pericardiotomy with drainage was performed under local anesthesia in patients with symptoms of cardiac tamponade or in patients with gradually increasing pericardial effusion estimated as more than 500ml by echocardiogram.In 2 patients, pericardial effusion was considered to be the result of overhydration;C-reactive protein was negative, and the LDH-ratio of pericardial effusion/plasma was as low as 0.5 and 0.6.Ten other patients developed pericardial effusion between 15 days and 6 years after the beginning of hemodialysis.Initial symptoms were fever (37-38°C), chest pain or discomfort, cough and palpitation, and they often preceded cardiomegaly. It was diagnosed as uremic pericarditis; C-reactive protein was strongly positive in all cases, and the LDH-ratio was as high as 2.5-13.4, with an average of 6.0. Neither recurrence nor pericardial adhesion was seen.In some cases, triamcinolone hexacetanide was injected through a catheter into the pericardial cavity repeatedly after pericardiotomy, but it was not shown to be effective. Massive pericardial effusion caused by uremic pericarditis should be removed early, and subxiphoid pericardiotomy with drainage is considered to be a sound and safe procedure of choice as compared with pericardiocentesis.
