Coronary Heart Disease in Chronic Renal Insufficiency

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Abstract
A partial explanation for these observations may come from the demographic characteristics of ESRD populations. Increased age is an important unmodifiable demographic factor associated with cardiovascular risk. During the past 15 yr, the median incident age of patients with ESRD in the United States has increased by more than a decade, from 53 yr in 1980 to 64 yr in 1995. Patients older than age 65 now represent nearly 68% of all new dialysis patients. Moreover, during the same time period, the greatest percentage increase in incidence of ESRD (nearly sevenfold) was seen in the those age 75 and older. As a result, there are nearly triple the number of those age 65 and older in dialysis populations than are in the general U.S. population (3). Because CVD is seen more commonly in older populations, it is not surprising that there is a high prevalence of preexisting comorbid cardiovascular conditions in new ESRD patients. Thus, for example, in 1997, 34.7% had a history of congestive heart failure, 25.1% had a history of coronary artery disease (CAD), 9.4% had a history of coronary myocardial infarction, and 15.6% had a history of coronary peripheral vascular disease, a surrogate marker for CAD (4). Such preexisting cardiovascular conditions have long been known to adversely affect ESRD survival.

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