Clinical aspects of cardiomyopathy in dialysis patients.
The burden of cardiac disease in dialysis patients is high. Congestive heart failure, ischemic heart disease, left ventricular hypertrophy, and systolic dysfunction occur frequently and are associated with an adverse prognosis. In addition, during dialysis therapy anemia, hypoalbuminemia, low blood pressure, and lower serum creatinine levels are adverse predictors of mortality. Risk factors for systolic dysfunction include older age, ischemic heart disease, hyperparathyroidism, and smoking. Risk factors for left ventricular hypertrophy include older age, hypertension, anemia, and diabetes mellitus. Interventions with potential for improving cardiomyopathy include normalization of hematocrit with erythropoietin, improved uremia therapy, and angiotensin-converting enzyme inhibitors. Trials to determine the most appropriate interventions to reduce the impact of cardiac disease in chronic uremia are urgently required.
Parfrey
P S
PS
Division of Nephrology, Health Sciences Centre, St. John's, Nfld., Canada.
Harnett
J D
JD
D000367:Age Factors; D000368:Aged; D000740:Anemia / Q000453:epidemiology; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002170:Canada / Q000453:epidemiology; D009202:Cardiomyopathies / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D015331:Cohort Studies; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D004452:Echocardiography; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D006400:Hematocrit; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology; D006961:Hyperparathyroidism / Q000453:epidemiology; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D016019:Survival Analysis; D013599:Systole
D000806:Angiotensin-Converting Enzyme Inhibitors; D004921:Erythropoietin