The heart in uremia: role of hypertension, hypotension, and sleep apnea.
Cardiovascular disease is the leading cause of morbidity and mortality in end-stage renal disease. Causes include those usually found in the general population, those related to the uremic status, and those related to dialytic treatment. Hypertension, hypotension, anemia, hypoalbuminemia, malnutrition, dyslipidemia, reactive C protein, calcium-phosphate product, dialysis modalities, and hyperhomocysteinemia are discussed extensively. Special emphasis is put on hyperparathyroidism as a traditional toxin. The emergent role of sleep apnea has been confirmed in animal models as well as in humans studied using polysomnography. There are difficulties in diagnosing coronary disease, because angiography is not risk-free, is expensive, and should be reserved for patients having symptoms of heart failure and/or patients having diabetes mellitus, and/or patients entering a transplantation list. This allows patients with coronary disease to undergo coronary artery bypass (preferably) or percutaneous transluminal angioplasty. Patients for whom surgery is not appropriate should be treated using more traditional medical procedures.
De Santo
N G
NG
Chairs of Nephrology, Heart Surgery, Pharmacology, and Excellency Center for Heart Failure at the Second University of Naples, Naples, Italy.
Cirillo
M
M
Perna
A
A
De Santo
L S
LS
Anastasio
P
P
Pollastro
M R
MR
De Santo
R M
RM
Iorio
L
L
Cotrufo
M
M
Rossi
F
F
D000328:Adult; D017677:Age Distribution; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D015897:Comorbidity; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006334:Heart Function Tests; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007022:Hypotension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D015995:Prevalence; D006435:Renal Dialysis / Q000706:statistics & numerical data; D012307:Risk Factors; D017678:Sex Distribution; D012891:Sleep Apnea Syndromes / Q000209:etiology; D015996:Survival Rate; D014511:Uremia / Q000453:epidemiology* / Q000628:therapy