Cardiovascular risk in hemodialysis patients: a mechanistic approach.
A new formula is proposed to express the excess burden of cardiovascular risk faced by hemodialysis patients as a function of various inherent, acquired and potentially modifiable factors. The proposed equation CVR(HD) = CVR(B) X f(([CKD+HD]/[HD(tech)+Dr])+X) includes the terms: CVR(HD) (cardiovascular risk in hemodialysis patients); CVR(B) (baseline cardiovascular risk); CKD (risk associated with chronic kidney disease); HD (risks associated with the process of hemodialysis); HD(tech) (benefits of new hemodialysis technologies); Dr (benefits of drug therapies) and X (unknown or putative factors influencing cardiovascular morbidity). We review the various factors included in this proposed formula, touching upon the epidemiology, pathophysiology and therapeutic implications, including possible strategies to modify risk. As is apparent from the formula, CKD and HD in particular act as risk multipliers in augmenting or amplifying the baseline cardiovascular risk, while new hemodialysis technologies may provide an opportunity for "cardioprotective dialysis". Drug treatment may serve to mitigate some of the risk unique to this population.
House
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University of Western Ontario Division of Nephrology, University Hospital, London Health Sciences Centre, London, Ontario, Canada. andrew.house@lhsc.on.ca
Ronco
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D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D002908:Chronic Disease; D006801:Humans; D007674:Kidney Diseases / Q000150:complications* / Q000628:therapy; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods; D012307:Risk Factors