Severe asymptomatic coronary obstruction in chronic hemodialysed patient - a case report

Arterial stiffness and vascular calcifications are independent predictors of cardiovascular morbidity and mortality in the chronic kidney disease (CKD) stage 5D population. According to the guidelines, patients on renal replacement therapy represent a very high cardiovascular risk class. We report t...

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Bibliographic Details
Published in:Journal of medicine and life 2016-10, Vol.9 (4), p.424-428
Main Authors: Voiculeț, C, Zara, O, Văcăroiu, I, Bogeanu, C, Tiron, T, Turcu, F, Aron, G, Ciocâlteu, A
Format: Article
Language:English
Subjects:
Aged
Case Presentations
Coronary Angiography
Coronary Artery Disease - complications
Coronary Artery Disease - diagnostic imaging
Coronary Vessels - diagnostic imaging
Coronary Vessels - pathology
Humans
Male
Renal Dialysis
Renal Insufficiency, Chronic - complications
Renal Insufficiency, Chronic - diagnostic imaging
Risk Factors
Tibia - blood supply
Vascular Calcification - complications
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Summary:Arterial stiffness and vascular calcifications are independent predictors of cardiovascular morbidity and mortality in the chronic kidney disease (CKD) stage 5D population. According to the guidelines, patients on renal replacement therapy represent a very high cardiovascular risk class. We report the case of a 67-year-old hypertensive male patient, known with CKD stage 5D on hemodialysis (three times per week), secondary bone mineral disease, admitted for progressive right leg pain. The physical examination detected right dorsalis pedis artery pulse absence. Blood biochemistry emphasized hypercalcemia, hyperphosphatemia, increased alkaline phosphatase, metabolic acidosis, hypoalbuminemia, iPTH values above upper limits. The X-ray of right shin highlighted a vascular calcification with a "train track" aspect on the tibial-peroneal artery trunk and the thoracic X-ray (performed with low ray regime) showed calcium deposits in coronary arteries walls. Legs arteriography and coronary angiography were performed revealing multiple lesions on investigated vessels with an 80% narrowing of right coronary artery. The particularity of the case lies in the absence of angina in a chronic hemodialysis patient in whom multiple significant angiographically stenosis of the coronary arteries were found and successful endovascular therapy was performed. The broadening of the indication for coronary angiography should be considered in certain asymptomatic CKD stage 5D patients based on a risk score involving calcium, phosphate, PTH and acid-base imbalances, while considering their major influence on the structure and tone of vascular walls thus on cardiovascular morbidity and mortality rates. ABI = ankle-brachial index,CAD = coronary artery disease,CKD = chronic kidney disease,CT = computed tomography, EBCT = electron-beam computed tomography,ESRD = end-stage renal disease,GFR = glomerular filtration rate,iPTH = intact parathormon,PCI = percutaneous coronary intervention.
ISSN:1844-122X
1844-3117