Cardiovascular complications in chronic dialysis patients

Abstract

Structured abstract Purpose of review This review article focuses on the most significant cardiovascular complications in dialysis patients (sudden cardiac death, acute coronary syndromes, heart failure, and atrial fibrillation). Recent findings Current and ongoing research aims to quantify the rate and pattern of significant arrhythmia in dialysis patients and to determine the predominant mechanism of sudden cardiac death. Preliminary findings from these studies suggest a high rate of atrial fibrillation and that bradycardia and asystole may be more frequent than ventricular arrhythmia as a cause of sudden death. A recently published matched cohort study in dialysis patients who received a defibrillator for primary prevention showed that there was no significant difference in mortality rates between defibrillator -treated patients and propensity matched controls. Two randomized controlled trials are currently recruiting participants and will hopefully answer the question whether implantable or wearable cardioverter-defibrillators can prevent sudden cardiac death. An observational study using USRDS data demonstrated how difficult it is to keep hemodialysis patients on warfarin, as more than two thirds discontinued the drug during the first year. The ISCHEMIA-CKD trial may provide answers about the optimal strategy for treatment of atherosclerotic coronary disease in patients with advanced CKD. Summary The article reviews diagnosis of acute coronary syndromes in dialysis patients, current literature on myocardial revascularization, and data on fatal and non-fatal cardiac arrhythmia. The new classification of heart failure in end-stage renal disease is reviewed. Finally, available cohort studies on warfarin for stroke prevention in dialysis patients with atrial fibrillation are reviewed.

Treatment effects of renin-angiotensin aldosterone system blockade on kidney failure and mortality in chronic kidney disease patients

“…Our results found a very high risk of death after ESRD diagnosis which corresponded with the study from Chinese ESRD subjects that the risk of death was high as 50% after 5 years follow-up [ 54 ] and could not demonstrate the beneficial effect of RAAS on death after ESRD diagnosis. It was found that sudden cardiac death was the major cause of death among ESRD patients and the underlying mechanism may be cardiac arrthymia which contribute by bradycardia or asystole or ventricular tachycardia [ 55 – 57 ]. In addition, the post hoc analysis among the CHOICE (Choices for Healthy Outcomes In Caring for ESRD) cohort of 1041 incident dialysis patients reported that sudden cardiac death is common among patients with ESRD and that inflammation and malnutrition significantly increased its occurrence independent of traditional cardiovascular risk factors [ 58 ].…”

Changes of Left and Right Ventricle Mechanics and Function in Patients with End-Stage Renal Disease Undergoing Haemodialysis

“…CKD is known to be associated with cardiac abnormalities, including patients without heart failure [ 2 ]. Cardiovascular complications are the main cause of the end-stage renal disease (ESRD) patients morbidity and mortality [ 3 ]. The risk of cardiovascular diseases (CVD) increases even in the early stages of CKD [ 4 ].…”

The proportion hyperhomocysteinemia in chronic kidney disease patients

“…3 The risk for cardiovascular disease (CVD) morbidity and mortality remains high in all stages of CKD, 4 including in patients with hemodialysis. 5,6 More patients with CKD die of CVD than of the progression of kidney failure. 7 The increase of homocysteine level, referred as hyperhomocysteinemia, is highly prevalent in CKD patients 8 and associated with an increased risk of CVD complications.…”