**5.2 Coronary artery disease in nondiabetic hemodialysis patients**

It is increasingly appreciated that chronic renal failure alone is an independent risk factor for the development of coronary artery disease. For evaluating the determinants of coronary artery disease in nondiabetic hemodialysis patients, among 312 consecutive patients on regular hemodialysis, 26 nondiabetic patients with angiographically defined coronary artery disease were compared with a subject group of nondiabetic hemodialysis patients of the same gender, smoking status, and hypertension with similar ages and body mass indexes, who had normal electrocardiography and myocardial perfusion scintigraphy. Demographics, CRP, ESR, Hct-corrected ESR, beta 2 microglobulin, cardiac troponin I, parathyroid hormone, albumin, calcium X phosphorus, and lipid profiles were compared between the groups. The nondiabetic patients with coronary artery disease had higher CRP, higher cardiac troponin I, and lower HDL-cholesterol levels than the patients without coronary artery disease. Backwards stepwise logistic regression analysis revealed that high CRP and troponin I levels and low HDL cholesterol levels were independently related with coronary artery disease in nondiabetic hemodialysis patients (Zumrutdal et al., 2007).

The predictive value of CRP in CV risk and mortality in hemodialysis patients was previously shown in numerious studies, and underlying coronary artery disease may be one of the possible links for this elevation. Additionally, even small elevations of serum cardiac troponin I concentration, at levels lower than those traditionally used for the diagnosis of acute events, were independently associated with the presence of coronary artery disease in asymptomatic hemodialysis patients. Thus, small and non-specific increases in cardiac troponin I levels may reflect underlying coronary artery disease in nondiabetic hemodialysis patients.

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