Key result
End-stage kidney disease patients had higher rates of inadequate myocardial blood flow response to dipyridamole than controls (p=0.006) and a lower incidence of ischemia (8% vs 24%; p<0.001).
Why the study?
Rb-PET-CT can measure myocardial blood flow to verify the response to vasodilator stress, making scan results more reliable.
Does end-stage kidney disease reduce the myocardial blood flow response to dipyridamole stress testing compared to normal kidney function?
Observational (n=428)
Does end-stage kidney disease reduce the myocardial blood flow response to dipyridamole stress testing compared to normal kidney function?
Answers are grounded in this paper and cite their sources.
ESKD patients have a blunted myocardial blood flow response to dipyridamole stress testing, leading to a higher probability of false-negative ischemia results.
BACKGROUND: Rb-positron emission tomography-computed tomography can measure myocardial blood flow (MBF), the response to vasodilator stress can be verified rendering the results of the scan more reliable. METHODS: We reviewed the MBF response to dipyridamole infusion in 328 patients with end-stage kidney disease (ESKD) prior to transplant (188 hemodialysis-HD, 120 peritoneal dialysis-PD, and 20 pre-dialysis patients-CKD5) and in 100 controls with normal kidney function. A stress/rest MBF ratio ≥ 2 was considered an adequate response to dipyridamole. Coronary artery calcium (CAC) was measured on CT. RESULTS: Inadequate MBF response was seen in 36%-HD, 21%-PD, 45%-CKD5 vs. 23%-controls (p = 0.006). Univariable predictors of poor MBF response in ESKD patients were age, diabetes mellitus, and CAC (all p < 0.03) while serum hemoglobin was borderline significant (p = 0.052). Multivariable predictors of a poor MBF response were age (p = 0.002) and lower serum hemoglobin (p = 0.014). Ischemia was identified in 8% of ESKD patients and 24% of controls (p < 0.001). CONCLUSIONS: ESKD patients are less likely to respond appropriately to vasodilator stress compared to patients with normal renal function and had a lower incidence of ischemia despite a high pre-test probability of disease. Physicians performing vasodilator stress without MBF measurement should be aware of the high probability of a false negative response.
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Malak et al. (2020) conducted an observational in End-stage kidney disease (n=428). End-stage kidney disease vs. Normal kidney function was evaluated on Inadequate myocardial blood flow response to dipyridamole infusion (p=0.006). End-stage kidney disease patients had higher rates of inadequate myocardial blood flow response to dipyridamole than controls (p=0.006) and a lower incidence of ischemia (8% vs 24%; p<0.001).
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