Heart evaluation in Dialysis patients.

 The reason for writing this post specifically is to educate Chronic kidney disease patients about the need to undergo evaluation for heart disease through coronary angiogram.

It has been difficult for me to convince patients regarding the need for coronary angiogram as it is seen as an additional financial burden and with suspicion. It is important to understand that both these diseases are a continum of a disease spectrum linked to vascular health.

Patients who are undergoing coronary angiogram on advice are doing so because of respect towards doctor or because of fear rather than knowledge about heart disease in Chronic kidney disease patients.

The reason for this is lack of knowledge among patients and also rising distrust on medical profession.

To add to this, referring primary care physicians also see it as a burden to the patient and may advice against it, but to be frank once a patient has CKD they immediately don't suffer but in long run they succumb to heart disease which the primary care physician wouldn't have appreciated as they happen in renal care units or in dialysis.

As a nephrologist we see heart related deaths very frequently which other physicians and even cardiologists wouldn't see.

> 50% of deaths in kidney patients especially those on dialysis die because of heart attacks and this number is alarming.

Apart from deaths there is frequent hospitalisation and hypotension or other complications during dialysis.

Simplifying the whole issue every patient more than 50 yrs who is having CKD and is on dialysis should undergo coronary angiogram to protect themselves from heart related deaths and complications in dialysis.

Any doctor advising Coronary angiogram is doing it in the benefit of patients in long run as against those who are not.

Unfortunately angigram is risky in Chronic kidney patients not on dialysis because there will be rapid progression of kidney disease and sometimes may need hemodialysis. Unless absolutely necessary angiogram is not done in chronic kidney patients not on Dialysis.

And finally doing an angiogram doesn't mean stenting and if no blocks are seen on angiogram we can at least be free of fear from dying because of heart related complications during dialysis.

Prevention is better than cure and here it's even more as there is no cure.