Cardiovascular risk assessment with regadenoson SPECT MPI in patients with end-stage renal disease is safe, effective, and well tolerated: Does it matter?

Excerpt

Patients with chronic kidney disease (CKD) constitute a special population that carries substantial risks of developing cardiovascular disease and complications of diagnostic and prognostic evaluation. Glomerular filtration rate (GFR) is inversely related to the rate of cardiovascular events, and patients with end-stage renal disease (ESRD) carry more than three times the risk of suffering a cardiovascular event compared with patients who have normal GFR.1 In recognition of this risk of excess morbidity and mortality of cardiovascular disease in this special population, the American College of Cardiology and the American Heart Association recommend considering CKD, a coronary heart disease risk equivalent.2 Diagnostic and prognostic assessments of patients with CKD pose serious potential safety concerns associated with the unique pathophysiology of CKD, including increased risk of iodinated contrast-induced nephropathy associated with invasive or CT coronary angiography, and nephrogenic systemic fibrosis with gadolinium cardiac magnetic resonance imaging.3 In patients with ESRD, mineralocorticoid excess, disordered bone and mineral metabolism, uremia, hyperhomocysteinemia, anemia, oxidative stress, inflammation, elevated norepinephrine and endothelin-1 levels cause vasoconstriction, frequent diabetes mellitus, depressed circulating endothelial progenitor cells (EPCs) for vascular repair, and enhanced vascular calcification which may predispose to the serious health risks of contrast exposure for diagnostic cardiac CT and MRI testing.4 The excess clinical cardiovascular morbidity and mortality, the diagnostic and prognostic evaluation risks, and the complex pathophysiologic metabolic, inflammatory, hormonal, and hematologic insults of patients with CKD including ESRD are compounded by underrepresentation in cohort studies validating methods for assessing cardiovascular disease in this special population.5 …