Cardiovascular impact in patients undergoing maintenance hemodialysis: Clinical management considerations

• Published in: International journal of cardiology Vol. 232; pp. 12 - 23
• Main Authors: Chirakarnjanakorn, Srisakul, Navaneethan, Sankar D., Francis, Gary S., Tang, W.H. Wilson
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.04.2017
• Subjects: Cardiovascular; Cardiovascular complications; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - etiology; Cardiovascular Diseases - therapy; Disease Management; End stage renal disease; Global Health; Hemodialysis; Humans; Incidence; Kidney Failure, Chronic - therapy; Renal Dialysis - adverse effects; Risk Factors; Survival Rate - trends; End stage renal disease; Hemodialysis; Cardiovascular complications; hemodialysis; cardiovascular complications
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2017.01.015

Patients undergoing maintenance hemodialysis develop both structural and functional cardiovascular abnormalities. Despite improvement of dialysis technology, cardiovascular mortality of this population remains high. The pathophysiological mechanisms of these changes are complex and not well understood. It has been postulated that several non-traditional, uremic-related risk factors, especially the long-term uremic state, which may affect the cardiovascular system. There are many cardiovascular changes that occur in chronic kidney disease including left ventricular hypertrophy, myocardial fibrosis, microvascular disease, accelerated atherosclerosis and arteriosclerosis. These structural and functional changes in patients receiving chronic dialysis make them more susceptible to myocardial ischemia. Hemodialysis itself may adversely affect the cardiovascular system due to non-physiologic fluid removal, leading to hemodynamic instability and initiation of systemic inflammation. In the past decade there has been growing awareness that pathophysiological mechanisms cause cardiovascular dysfunction in patients on chronic dialysis, and there are now pharmacological and non-pharmacological therapies that may improve the poor quality of life and high mortality rate that these patients experience. •Patients undergoing maintenance hemodialysis have a mix of ischemic, metabolic, and structural changes, coupled with the stress of hemodialysis.•The “classic” heart failure manifestations of patients with end-stage renal disease (ESRD) are somewhat atypical and therapeutic options are limited.•There have been advances in dialysis technologies as well as newer insights with novel imaging techniques.•Clinicians need to better appreciate the spectrum as well as the current understanding of this unique patient population.