AMI trong một đội quân của bệnh nhân chạy thận và người nhận cấy ghép thận được nhập viện AMI tại Hoa Kỳ. Có vẻ như là một mối nguy hiểm đầu tiên của AMI liên quan đến lọc máu bắt đầu, 52% của nhồi máu xảy ra trong vòng 2 năm bắt đầu lọc máu (so với 29% người nhận cấy ghép). | 22 Chapter 2 Figure 2 Cumulative occurrence of acute myocardial infraction related to duration of end-stage renal disease. From reference 23 with permission. occurrence of AMI in a cohort of 34 189 dialysis patients and 3079 renal transplant recipients hospitalized for AMI in the United States. There appears to be an early hazard of AMI related to dialysis initiation as 52 of infarcts occurred within 2 years of dialysis initiation vs 29 in transplant recipients . Dialysis may be a stress test for occult coronary artery disease or it conceivably may promote the development of acute coronary syndromes. This temporal clustering has implications for the diagnosis and treatment of ischemic heart disease in dialysis patients. In the United States high cardiac risk renal transplant candidates are typically screened for occult coronary artery disease. By the same logic the highest risk ESRD group for cardiac disease newly dialyzed patients should also be evaluated irrespective of transplant candidacy . It may be possible to identify a subset of dialysis patients at the highest risk for death perhaps with outpatient testing for the presence of increased serum cardiac troponin I and troponin T as both appear to prospectively identify dialysis patients at increased risk for mortality 26 27 . The detection and treatment of coronary artery disease before renal transplantation can potentially reduce the risk of adverse cardiac events. Current guidelines of the American Society of Transplantation recommend that patients at high risk for ischemic heart disease be screened before renal transplantation 28 29 . Figure 3 summarizes the algorithm employed at our own medical center for the evaluation and treatment of ischemic Figure 3 Algorithm for management of CAD in renal transplant candidates. From reference 30 with permission. Percutaneous coronary revascularization in patients with ESRD 23 24 Chapter 2 heart disease in renal transplant candidates. In our institution we rely on .
