Sharma Rajan
Department of Cardiology, Ealing Hospital NHS Trust, London, UK.
J Ren Care. 2010 May;36 Suppl 1:68-75. doi: 10.1111/j.1755-6686.2010.00167.x.
Cardiovascular disease remains the major cause of mortality and morbidity in patients with advanced chronic kidney disease (CKD) and after renal transplantation. The mechanisms for cardiotoxicity are multiple. Identifying high-risk patients remains a challenge. Given, the poor long-term outcome of dialysis patients who do not receive renal transplantation and the lower supply of donor kidneys relative to demand, optimal selection of renal transplantation candidates is crucial. This requires a clear understanding of the validity of cardiac tests in this patient group. This paper explores the strengths and weaknesses of currently available diagnostic tools in patients with advanced CKD. Echocardiography is very useful for the detection of cardiomyopathy and prognosis. Stress echocardiography, myocardial perfusion imaging and coronary angiography are the best tools for the assessment of coronary artery disease. All predict outcome. No single gold standard investigation exists. At present, there is not an optimal technique for predicting sudden cardiac death in this patient group. Ultimately, the choice of cardiac test will always be determined by patient preference, local expertise and availability.
心血管疾病仍然是晚期慢性肾脏病（CKD）患者及肾移植后患者死亡和发病的主要原因。心脏毒性的机制是多方面的。识别高危患者仍然是一项挑战。鉴于未接受肾移植的透析患者长期预后较差，且供体肾供不应求，因此优化肾移植候选者的选择至关重要。这需要清楚了解该患者群体心脏检查的有效性。本文探讨了晚期CKD患者目前可用诊断工具的优缺点。超声心动图对心肌病的检测和预后评估非常有用。负荷超声心动图、心肌灌注成像和冠状动脉造影是评估冠状动脉疾病的最佳工具。所有这些都能预测预后。不存在单一的金标准检查。目前，尚无预测该患者群体心源性猝死的最佳技术。最终，心脏检查的选择总是由患者偏好、当地专业知识和可及性决定。
