Diagnosis of Coronary Artery Disease in Patients with Chronic Kidney Disease and Occupational Exposures to Coronary Hazards - One of the Key Issues to Prevent Cardiac Karoshi

Background: The incidence of cardiovascular disease is very high in chronic kidney disease (CKD) and explains poor prognosis and almost half of deaths in these patients. Besides, exposure to occupational coronary hazards predisposes workers to coronary artery disease (CAD). We aim to explore the pattern of case benefits due to death from Bureau of Labor Insurance from 2019 and 2021 and secondary prevention of CAD. Methods: Database of PubMed, Document delivery service of Library of Taipei City Hospital, and Google scholar were searched for relevant key words. We also retrieved data from data.gov.tw of our government using creative commons and public license. Results: Cardiovascular disease progresses at twice the rate in CKD and is related to death before end stage renal disease. Patients with CKD are prone to cardiac Karoshi. Occupational hazards include overwork, ionizing radiation, dimethylformamide, high temperature work, carbon disulfide, and alkyl lead. High prevalence of exercise intolerance, atypical presentations, and abnormalities of baseline electrocardiogram contribute to difficulty in early diagnosis in patients with CKD. Thus, stress tests other than exercise electrocardiogram are needed in diagnosis of CAD in patients with CKD. Disadvantages, advantages, performance and criteria of screening tests were reviewed. Cerebrovascular and cardiovascular disorder (CCVD) plays an important role of case benefits due to death from Labor of insurance from 2019 and 2021. Conclusion: Occupational health physicians should be familiar with occupational exposures of coronary hazards and screening tests and play a key role in early diagnosis of CAD in CKD in order to avoid karoshi due to acute myocardial infarction and cardiac sudden death.