Cardiovascular impact in patients undergoing maintenance hemodialysis: Clinical management considerations
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 understo...
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| Published in | International journal of cardiology Vol. 232; pp. 12 - 23 |
|---|---|
| Main Authors | , , , |
| Format | Journal Article |
| Language | English |
| Published |
Netherlands
Elsevier B.V
01.04.2017
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0167-5273 1874-1754 |
| DOI | 10.1016/j.ijcard.2017.01.015 |
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| Abstract | 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. |
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| AbstractList | 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 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. Abstract 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. |
| Author | Chirakarnjanakorn, Srisakul Francis, Gary S. Navaneethan, Sankar D. Tang, W.H. Wilson |
| AuthorAffiliation | 1 Kaufman Center for Heart Failure, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 3 Division of Cardiology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand 2 Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX 4 Division of Cardiovascular Disease, University of Minnesota |
| AuthorAffiliation_xml | – name: 1 Kaufman Center for Heart Failure, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH – name: 2 Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX – name: 3 Division of Cardiology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand – name: 4 Division of Cardiovascular Disease, University of Minnesota |
| Author_xml | – sequence: 1 givenname: Srisakul surname: Chirakarnjanakorn fullname: Chirakarnjanakorn, Srisakul organization: Kaufman Center for Heart Failure, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States – sequence: 2 givenname: Sankar D. surname: Navaneethan fullname: Navaneethan, Sankar D. organization: Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States – sequence: 3 givenname: Gary S. surname: Francis fullname: Francis, Gary S. organization: Division of Cardiovascular Disease, University of Minnesota, United States – sequence: 4 givenname: W.H. Wilson orcidid: 0000-0002-8335-735X surname: Tang fullname: Tang, W.H. Wilson email: tangw@ccf.org organization: Kaufman Center for Heart Failure, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/28108129$$D View this record in MEDLINE/PubMed |
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| Snippet | Patients undergoing maintenance hemodialysis develop both structural and functional cardiovascular abnormalities. Despite improvement of dialysis technology,... Abstract Patients undergoing maintenance hemodialysis develop both structural and functional cardiovascular abnormalities. Despite improvement of dialysis... |
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| SubjectTerms | 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 |
| Title | Cardiovascular impact in patients undergoing maintenance hemodialysis: Clinical management considerations |
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