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	Ischaemic symptoms		Arrythmias
	Left-ventricular hyperthrophy		Pericardial disease
	Valvular disease		Hypertension
	Lipids		Anaemia
	Invasive management

Cardiovascular disease in patients with end-stage renal failure remains a major challenge. It is still the leading course of both mortality and morbidity in patients on dialysis. While we are still uncertain about reasons for this excess mortality, patients on dialysis undoubtedly carry an excess of conventional risk factors for the coronary artery disease (Table 1)

Table 1: Standard risk factors for coronary artery disease

		Smoking
		Abnormalities in lipid profile
		Hypertension
		Family history
		Diabetes mellitus
		Pre-existing atherosclerotic disease

Although the death rate from cardiac disease in the general population is falling, mortality has not changed among patients on dialysis. This may, in part, be owing to demographic changes within this sub-population.

 

		For example, the median age of patients entering dialysis programmes is now approaching 65 years.
		The percentage of dialysis patients in the UK who are diabetic has risen to between 15 and 25%.
		This figure is about 40% in the USA.

In addition, there are additional risk factors peculiar to renal-failure patients and their metabolic milieu which may also be relevant (Table 2)

Table 2: Factors related to uraemia

		Left-ventricular hypertrophy
		Hyperparathyroidism and abnormal calcium phosphate metabolism
		Vessel calcification
		Valvular calcification
		Myocardial fibrosis
		Effects on cellular-calcium metabolism
		Anaemia
		Decreased oxygen delivery
		A-V fistulae
		High output state
		PTFE grafts and tunnelled access
		Endocarditis
		Fluid overload
		Hypertension
		Valve incompetence
		Instability on dialysis
		"Heart failure"
		Metabolic abnormalities
		Arrhythmias
		Other putative "uraemic factors"
		Homecysteine, carnitine