What is the clinical evidence from this study?

Study design: Observational. Population: End-Stage Renal Disease (ESRD) on maintenance hemodialysis with hepatic dysfunction (n=369). Primary outcome: Prevalence and predictors of Coronary Artery Disease (CAD) (AOR 2.14, 95% CI 1.31-3.48, p=0.002).

What does this research mean for the field?

Coronary artery disease is present in 38.7% of ESRD patients on dialysis, and moderate-to-severe hepatic dysfunction independently increases the risk of CAD by over twofold. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

The study aimed to evaluate the prevalence of coronary artery disease (CAD) in end-stage renal disease (ESRD) patients with hepatic dysfunction and identify significant predictors for CAD.

March 18, 2026Open Access

Coronary Artery Disease in End-Stage Renal Disease Patients on Dialysis With Hepatic Dysfunction: Prevalence and Predictors

Key Result

Coronary artery disease was present in 38.7% of ESRD patients on dialysis, with moderate-to-severe hepatic dysfunction independently increasing the risk of CAD by over twofold (AOR 2.14).

Key Points

The study aimed to evaluate the prevalence of coronary artery disease (CAD) in end-stage renal disease (ESRD) patients with hepatic dysfunction and identify significant predictors for CAD.
Conducted at Mayo Hospital, Lahore, reviewing medical records from 369 ESRD patients on hemodialysis.
Assessed demographic characteristics, comorbidities, dialysis parameters, and laboratory findings.
Classified hepatic dysfunction severity using the Child-Pugh system and diagnosed CAD via angiography, echocardiography, and noninvasive testing.
The overall CAD prevalence was 38.7% among the studied population.
CAD-positive patients were older (mean age 61.2 years) with a higher prevalence of diabetes and dyslipidemia.
Longer dialysis duration was noted in CAD-positive patients (mean 4.9 years).
Age, diabetes mellitus, dialysis duration, elevated CRP, and moderate-to-severe hepatic dysfunction were identified as independent predictors of CAD.

Study Design

Type

Observational (n=369)

Multicenter

Structured PICO

Population

369 adults (aged ≥18 years) with end-stage renal disease (ESRD) undergoing maintenance hemodialysis for at least 3 months with documented hepatic dysfunction (Child-Pugh Class A-C). Mean age 57.8 years, 58.5% male. Excluded: acute kidney injury, acute hepatic failure, sepsis-related hepatic dysfunction, congenital heart disease, non-atherosclerotic cardiomyopathies.

Outcome

Prevalence of coronary artery disease (CAD), defined as ≥50% stenosis in a major coronary artery on angiography, regional wall motion abnormalities suggestive of ischemia on echocardiography, or documented myocardial ischemia on noninvasive stress testingsurrogate

In ESRD patients on maintenance hemodialysis, concurrent hepatic dysfunction significantly amplifies the risk of coronary artery disease, highlighting the need for aggressive cardiovascular risk stratification in this dual-organ impairment population.

Main Result

Effect estimate: AOR 2.14 (95% CI 1.31-3.48)

p-value: p=0.002

Limitations

Retrospective nature limits the ability to establish causal relationships
Unrecorded cardiovascular confounders including smoking status, BMI, and statin use
Diagnostic heterogeneity as not all patients underwent coronary angiography
Single-center study design may limit generalizability to broader populations

Abstract

Background: Patients with end-stage renal disease (ESRD) undergoing maintenance dialysis are at markedly increased risk of coronary artery disease (CAD). The presence of hepatic dysfunction is frequently observed in this population and may be associated with additional metabolic and inflammatory disturbances that influence cardiovascular outcomes. Objective: This study assessed the prevalence of CAD and identified its significant predictors among ESRD patients with concurrent hepatic impairment. Methods: A retrospective observational study was conducted at Mayo Hospital, Lahore, from August 2024 to August 2025, reviewing medical records of 369 ESRD patients undergoing maintenance hemodialysis with documented hepatic dysfunction. Demographic characteristics, comorbidities, dialysis-related parameters, laboratory findings, and hepatic profiles were extracted. Hepatic dysfunction severity was classified using the Child-Pugh system. CAD was diagnosed based on ≥50% coronary artery stenosis on angiography, regional wall motion abnormalities on echocardiography suggestive of ischemia, or positive noninvasive ischemia testing. Results: The mean age of the participants was 57.8 ± 11.6 years, and 58.5% were male. The overall prevalence of CAD was 38.7% (n = 143). Among CAD-positive patients, 59 (41.3%) had angiographic stenosis ≥50%, 48 (33.6%) demonstrated regional wall motion abnormalities on echocardiography, and 36 (25.2%) had positive noninvasive ischemia tests. Patients with CAD were significantly older (61.2 ± 10.7 vs. 55.9 ± 11.8 years, p < 0.001) and had a higher prevalence of diabetes mellitus and dyslipidemia. Dialysis duration was longer in CAD-positive patients (4.9 ± 2.4 vs. 3.8 ± 1.9 years, p < 0.001). Multivariable regression analysis identified older age (AOR 1.04, 95% CI 1.02-1.07), diabetes mellitus (AOR 1.89, 95% CI 1.20-2.98), prolonged dialysis duration (AOR 1.28, 95% CI 1.12-1.46), elevated CRP (AOR 1.75, 95% CI 1.08-2.84), and moderate-to-severe hepatic dysfunction (AOR 2.14, 95% CI 1.31-3.48) as independent predictors of CAD, while albumin demonstrated a protective association (AOR 0.72, 95% CI 0.54-0.96). Conclusion: CAD is highly prevalent among ESRD patients undergoing maintenance dialysis with concurrent hepatic dysfunction. Age, diabetes mellitus, dialysis duration, systemic inflammation, and severity of hepatic impairment significantly contribute to CAD risk in this population.

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