Newer paradigms in renal replacement therapy: will they alter cardiovascular outcomes?
Cardiovascular disease remains the leading cause of morbidity and mortality for patients with end-stage renal disease. Conventional hemodialysis has had limited impact on cardiovascular risk factors and mortality. Increasing evidence suggests that nocturnal home hemodialysis has beneficial effects on cardiovascular parameter outcomes. This article reviews the documented effects of nocturnal home hemodialysis on blood pressure control, cardiac geometry and left ventricular systolic function, lipid profiles, calcium-phosphate metabolism, parathyroid hormone levels, homocysteine levels, sleep apnea, and autonomic modulation of heart rate. It discusses possible mechanisms to explain these observed changes.
Kundhal
Kiran
K
Division of Nephrology, Department of Medicine, Toronto General Hospital-University Health Network, 12 Eaton North, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada.
Pierratos
Andreas
A
Chan
Christopher T
CT
D002318:Cardiovascular Diseases / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D020138:Hyperhomocysteinemia / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D006949:Hyperlipidemias / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D006962:Hyperparathyroidism, Secondary / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D000860:Hypoxia / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D007676:Kidney Failure, Chronic / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D006435:Renal Dialysis; D012891:Sleep Apnea Syndromes / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D016896:Treatment Outcome