Acute MI in dialysis patients: How can we improve the outlook?: Formidable risk warrants vigorous intervention, not therapeutic nihilism

In comparison with the population as a whole, patients undergoing long- term dialysis have a drastically elevated risk of death from cardiovascular causes, including acute myocardial infarction (MI). Besides the many cardiac risk factors that are common among these patients, conventional three-times- a-week dialysis schedules may create a hazard in the form of increased volume stress and hyperkalemia after the 2-day weekend interval. The frequency of chest pain and dyspnea related to volume overload also has the potential to confound the diagnosis of acute MI. It appears reasonable to screen all patients for coronary artery disease when they begin dialysis; dobutamine stress echocarcliography is an imperfect but useful technique. Thrombolytic therapy appears to be underused in treating dialysis patients with acute MI. The treatment that these patients receive should be similar to that given to patients without renal disease.