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

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.