Cardiac disease in chronic uremia: investigation.

Cardiovascular disease continues to be the leading cause of death in the end-stage renal disease (ESRD) population, accounting for nearly half of the deaths among the dialysis population. The purpose of this article is to review the clinical screening tools available to the attending nephrologist and consulting cardiologist to detect both symptomatic and asymptomatic cardiovascular disease in ESRD patients. The author presents a detailed overview of (1) assessment of left ventricular (LV) function in the hemodialysis population and (2) noninvasive cardiovascular screening in patients before anticipated renal transplantation. Specific guidelines are offered for the pretransplantation evaluation of cardiac disease based on the patient's cardiovascular risk factors, symptomatology, and stress testing with either thallium or dobutamine echocardiography. Recent studies of cardiovascular screening in selected hemodialysis populations may not be extrapolated to the general ESRD population pending further investigation. Crucial questions relating to the utility of cardiovascular screening and intervention in the general ESRD population remain and deserve further study.