S THIRUVENGADAM1,2, N KANGAHARAN1,3, M SUNDARAM1
1Royal Darwin Hospital, Darwin, Australia, 2Royal Perth Hospital, Perth, Australia, 3NT Cardiac, Darwin, Australia
Aim: To establish the prevalence of angiographic coronary artery disease in haemodialysis patients in the Top end.
Background: Cardiovascular disease is associated with morbidity and mortality in patients with renal disease and is predominant in Indigenous patients due to various risk factors.
Methods: A database of prevalent haemodialysis patients in the Top End on July 2016 was obtained, including in-centre, satellite and home-dialysis units. Clinical information was extracted from medical records and the NT Cardiac database. Angiographic findings were classified into none (Grade 0), mild (Grade 1, <50% stenosis), moderate (Grade 2, 50- 70% stenosis) and severe (Grade 3, >70% stenosis) disease.
Results: Of 222 patients, 120 (54.1%) had an angiogram. There were 99 Indigenous, 14 Caucasian and 7 patients of other races, with an average age of 56 and a male to female ratio of 64:56.Hundred-and-one patients (84.2%) had LAD disease, 94 patients (78.3%) had circumflex disease, 94 patients (78.3%) had RCA and 58 (48.3%) had left main disease. Fifty-six patients (46.7%) had 3-vessel and left main disease. The average severity was 1.62 with LAD, 1.58 with RCA and 1.36 with circumflex disease.The vessel involved, severity, and left ventricular dysfunction were not different between Indigenous and non-Indigenous patients. Although not statistically significant, Indigenous patients had more multi-vessel disease (2.91 vs 2.36, p = 0.44) and tended to be younger (54.7 vs 59.7 years, p=0.07)
Conclusion: Despite limitations of retrospective data and selection bias, this descriptive study on haemodialysis patients in the Top End establishes that at least half had cardiac symptoms or ischaemia requiring an angiogram, and nearly half had severe triple vessel disease. These results call for cautious screening and management.
Dr. Madhi Sundaram is a Nephrologist working at the Royal Darwin Hospital. Dr Sundaram graduated at Christian Medical College, Vellore in 2007 and worked as a consultant in the same hospital before relocating to Darwin in 2011. Dr Sundaram has more than 25 publications and is now pursuing research in immunologically mediated renal conditions and inherited renal disorders in Indigenous subjects. He is now collaborating with the Victorian clinical Genetic Services and the KIDGEN to establish an active renal genetics clinic in Royal Darwin Hospital.