Hypocalcemic Heart Failure in End-Stage Renal Disease

Wong, Cheuk‐Kit; Pun, Kong-Pang; Cheng, C. C.; Lau, Chu‐Pak; Leung, Wing-Hung; Chan, Michael C. W.; Yeung, David W.C.

doi:10.1159/000168073

Cited by 15 publications

(9 citation statements)

References 10 publications

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“…It appears probable that these patients could have tolerance to such complications in long‐standing cases in which plasma calcium levels decrease slowly over years or decades. Thus, in many cases of hypocalcemic heart failure, 2–6 including ours, symptoms of neuromuscular irritability of hypocalcemia, such as tingling and tetany, were absent. Apart from the patient's mild disorientation, he did not have neurologic complications.…”

Section: Discussionmentioning

confidence: 62%

Severe Hypocalcemia: A Rare Cause of Reversible Heart Failure

Mikhail

El-Bialy

Grosser

2001

Congestive Heart Failure

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Despite the crucial role of calcium in myocardial contractility, hypocalcemia has been rarely reported as a cause of heart failure. In this article, the authors describe a case of severe hypocalcemia caused by idiopathic hypoparathyroidism and worsened by concomitant hypomagnesemia. The patient presented with congestive heart failure that improved dramatically with amelioration of plasma calcium levels. This case and other similar cases in the literature revealed that hypocalcemic heart failure is reversible. Measurement of plasma calcium should be included in the initial work-up of all patients with heart failure, and plasma magnesium must also be checked and corrected if hypocalcemia is demonstrated. (c)2001 CHF, Inc.

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Section: Discussionmentioning

confidence: 62%

Severe Hypocalcemia: A Rare Cause of Reversible Heart Failure

Mikhail

El-Bialy

Grosser

2001

Congestive Heart Failure

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“…Nevertheles, only 2 uremic patients with hypocalcemic heart failure have been reported: 1 with pericarditis [3] and another with severe hypocalcemia [4], Considering the pres ent case together with the previously reported cases, we think that an acute decline in serum calcium is an additional prerequisite for the development of hypocalcemic heart failure.…”

Section: Discussionmentioning

confidence: 75%

“…Hemodialysis repor tedly improves left ventricular function not only by a FrankStarling effect due to volume reduction but also by an increase in the cardiac contractility possibly due to an increase in serum calcium [2], Although hypocalcemia is a common clinical feature of chronic renal failure, it rarely causes an overt depression of cardiac contractility in uremic Accepted : July 19.1991 patients. To the best of our knowledge, only 2 uremic patients who developed heart failure as a result of hypocal cemia have been reported [3,4]. Here we report a uremic patient treated with hemodialysis for 13 years who devel oped acute hypotension during hemodialysis and overt heart failure subsequently by relatively mild hypocalcemia after parathyroidectomy.…”

Section: Introductionmentioning

confidence: 85%

Exacerbation of Latent Heart Failure by Mild Hypocalcemia after Parathyroidectomy in a Long-Term Hemodialysis Patient

Shinoda¹,

Aizawa²,

Shirota³

et al. 1992

Nephron

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A 60-year-old uremic patient treated with hemodialysis for 13 years developed acute hypotension during hemodialysis and overt heart failure subsequently in a period of relatively mild hypocalcemia after parathyroidectomy. Blood pressure during hemodialysis was maintained by continuous calcium infusion alone. Cardiomegaly was improved by normalization of serum calcium. The cardiac complication is considered to be exacerbation of the underlying myocardial dysfunction by the acute decline of serum calcium which might be a feature of the ‘hungry bone’ syndrome. Latent myocardial dysfunction might be exacerbated by only mild hypocalcemia after parathyroidectomy in long-term hemodialysis patients.

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“…Therefore, correction of hypocalcaemia via CVVH may improve cardiac function in ADHF. While data on this specific potential benefit of CVVH is lacking, there have been reports of correction of hypocalcaemia in patients with renal dysfunction reversing decompensated heart failure (25). Therefore, given the potential benefits of correction of metabolic derangements with limited added risk if extracorporeal therapy is already employed, CVVH may be a better alternative to SCUF for the treatment of ADHF in the intensive care unit (where CVVH is typically performed).…”

Section: Continuous Venovenous Hemofiltrationmentioning

confidence: 99%

THE CLINICAL APPLICATION OF CRRT—CURRENT STATUS: The Use of Renal Replacement Therapy in Acute Decompensated Heart Failure

Udani

Murray

2009

Seminars in Dialysis

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The worsening of renal function in the context of decompensated heart failure is an increasingly common clinical scenario, dubbed the cardiorenal syndrome. Its development is not completely understood; however, it results from the hemodynamic and neurohumoral alterations that occur in the setting of left ventricular pressure and volume overload with poor cardiac output. Diuretics have been the mainstay of treatment; however, they are often unsuccessful in reversing the vicious cycle of volume overload, worsening cardiac function, and azotemia. Renal replacement therapy (RRT) in the form of isolated or continuous ultrafiltration (UF) with or without a component of solute clearance (hemofiltration or hemodialysis) has been increasingly utilized as a therapeutic tool in this setting. Initial clinical trial data on the use of UF have demonstrated promising cardiac outcomes with regard to fluid removal and symptom relief without worsening renal function. The addition of a component of solute clearance may provide additional benefits in these patients with varying degrees of renal impairment. The exact clinical setting in which the various forms of RRT should be applied as initial or early therapy for acute decompensated heart failure (ADHF) remains unknown. More research examining the use of RRT in ADHF is necessary; however, it appears that the patients with the most severe clinical presentations have the best chance of benefiting from the early application of RRT.

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Hypocalcemic Heart Failure in End-Stage Renal Disease

Cited by 15 publications

References 10 publications

Severe Hypocalcemia: A Rare Cause of Reversible Heart Failure

Severe Hypocalcemia: A Rare Cause of Reversible Heart Failure

Exacerbation of Latent Heart Failure by Mild Hypocalcemia after Parathyroidectomy in a Long-Term Hemodialysis Patient

THE CLINICAL APPLICATION OF CRRT—CURRENT STATUS: The Use of Renal Replacement Therapy in Acute Decompensated Heart Failure

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