title: Intradialytic hypotension and cardiac remodeling: a vicious cycle.
abstract: Hemodynamic instability during hemodialysis is a common but often underestimated issue in the nephrologist practice. Intradialytic hypotension, namely, a decrease of systolic or mean blood pressure to a certain level, prohibits the safe and smooth achievement of ultrafiltration and solute removal goal in chronic dialysis patients. Studies have elucidated the potential mechanisms involved in the development of Intradialytic hypotension, including excessive ultrafiltration and loss of compensatory mechanisms for blood pressure maintenance. Cardiac remodeling could also be one important piece of the puzzle. In this review, we intend to discuss the role of cardiac remodeling, including left ventricular hypertrophy, in the development of Intradialytic hypotension. In addition, we will also provide evidence that a bidirectional relationship might exist between Intradialytic hypotension and left ventricular hypertrophy in chronic dialysis patients. A more complete understanding of the complex interactions in between could assist the readers in formulating potential solutions for the reduction of both phenomena.
authors: Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Jin-Shan Branch, 51 Nan-Shih, Jin-Shan District, New Taipei City 208, Taiwan ; Graduate Institute of Toxicology, National Taiwan University Medical School, Section 1, 1 Jen-Ai Road, Zhong-Zheng District, Taipei 100, Taiwan.
authors: Chia-Ter
authors: 0000-0003-2892-7986
authors: CT
authors: Chao
authors: Renal Division, Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Zhong-Zheng District, Taipei 100, Taiwan.
authors: Jenq-Wen
authors: JW
authors: Huang
authors: Renal Division, Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Zhong-Zheng District, Taipei 100, Taiwan ; Department of Geriatrics and Gerontology, National Taiwan University Hospital, 7 Chung-Shan South Road, Zhong-Zheng District, Taipei 100, Taiwan.
authors: Chung-Jen
authors: CJ
authors: Yen
mesh_terms: D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D007022:Hypotension / Q000209:etiology* / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000503:physiopathology; D008954:Models, Biological; D006435:Renal Dialysis / Q000009:adverse effects*; D020257:Ventricular Remodeling
references: Am J Kidney Dis. 2005 Apr;45(4 Suppl 3):S1-153
references: 15806502
references: J Mol Cell Cardiol. 2012 Apr;52(4):857-64
references: 21924273
references: Echocardiography. 2009 Aug;26(7):767-71
references: 19486120
references: Nephrol Dial Transplant. 2000 Nov;15(11):1746-8
references: 11071958
references: Am J Kidney Dis. 2008 Feb;51(2):255-62
references: 18215703
references: Kidney Int. 2007 Mar;71(5):454-61
references: 17213873
references: Clin J Am Soc Nephrol. 2009 Dec;4 Suppl 1:S79-91
references: 19996010
references: J Hypertens. 2006 Jun;24(6):1173-80
references: 16685218
references: Hypertension. 2009 Oct;54(4):818-24
references: 19635983
references: Ren Fail. 2008;30(7):701-9
references: 18704819
references: Am Heart J. 1985 Mar;109(3 Pt 1):539-45
references: 4038842
references: Europace. 2000 Jul;2(3):216-23
references: 11227591
references: Clin J Am Soc Nephrol. 2007 Jul;2(4):661-8
references: 17699479
references: Kidney Int. 2009 Apr;75(8):771-3
references: 19337217
references: Circ J. 2008 Jun;72(6):926-31
references: 18503218
references: Heart Rhythm. 2009 Apr;6(4):522-7
references: 19250876
references: Blood Purif. 1994;12(4-5):277-83
references: 7865187
references: Circulation. 2013 Feb 5;127(5):569-74
references: 23275377
references: Am J Kidney Dis. 1998 Nov;32(5 Suppl 3):S112-9
references: 9820470
references: Cardiorenal Med. 2012 May;2(2):125-133
references: 22851961
references: Clin Auton Res. 2002 Apr;12(2):84-7
references: 12102455
references: Clin J Am Soc Nephrol. 2009 May;4(5):914-20
references: 19357245
references: Cardiovasc Res. 1988 Oct;22(10):686-95
references: 2978464
references: Kidney Int. 2012 Oct;82(8):920-7
references: 22763817
references: Kidney Int. 2004 Sep;66(3):1212-20
references: 15327420
references: Artif Organs. 2012 Oct;36(10):901-10
references: 22845774
references: Kidney Int. 2002 Jul;62(1):339-45
references: 12081596
references: J Am Soc Hypertens. 2013 May-Jun;7(3):206-15
references: 23538140
references: Am J Cardiol. 2002 Dec 15;90(12):1284-9
references: 12480035
references: J Nephrol. 2010 Jan-Feb;23(1):55-61
references: 20091487
references: Kidney Int. 1998 Nov;54(5):1720-5
references: 9844150
references: J Hypertens. 2000 Nov;18(11):1645-50
references: 11081778
references: Ann Intern Med. 1988 Jan;108(1):7-13
references: 2962527
references: J Am Soc Nephrol. 2001 Dec;12(12):2759-67
references: 11729246
references: Am J Kidney Dis. 2005 Aug;46(2):320-7
references: 16112052
references: J Am Soc Nephrol. 2001 Dec;12(12):2768-74
references: 11729247
references: Am J Kidney Dis. 2008 Nov;52(5):962-71
references: 18706751
references: Am J Med Sci. 2003 Apr;325(4):168-78
references: 12695722
references: Kidney Int. 1991 Feb;39(2):233-46
references: 2002637
references: Ren Fail. 2009;31(3):239-45
references: 19288330
references: Kidney Int. 1995 Jan;47(1):186-92
references: 7731145
references: J Am Soc Nephrol. 2011 Feb;22(2):349-57
references: 21233416
references: J Am Coll Cardiol. 1984 Jun;3(6):1500-6
references: 6232306
references: Eur J Intern Med. 2012 Dec;23(8):711-5
references: 22958951
references: Kidney Int. 2007 Feb;71(4):318-24
references: 17003815
references: Nephrol Dial Transplant. 2006 Nov;21(11):3231-7
references: 16954178
references: PLoS One. 2013;8(6):e66036
references: 23762460
references: Kidney Int. 2001 May;59(5):1834-41
references: 11318954
references: Am J Kidney Dis. 2001 Oct;38(4 Suppl 4):S11-7
references: 11602456
references: Nephrol Dial Transplant. 2011 May;26(5):1645-51
references: 20923927
references: PLoS One. 2012;7(12):e50675
references: 23251377
references: J Am Soc Nephrol. 2007 Apr;18(4):1316-22
references: 17360950
references: Ren Fail. 2001 Sep;23(5):637-49
references: 11725910
references: J Am Coll Surg. 2013 Aug;217(2):240-50
references: 23870218
references: Circ Res. 1995 Mar;76(3):489-97
references: 7859394
references: Nephrol Dial Transplant. 2007 May;22(5):1420-7
references: 17299006
references: Circ Arrhythm Electrophysiol. 2013 Apr;6(2):243-51
references: 23403268
references: J Am Soc Nephrol. 2010 Oct;21(10):1798-807
references: 20813866
references: JAMA. 1996 May 22-29;275(20):1557-62
references: 8622246
references: Am J Kidney Dis. 2006 May;47(5):830-41
references: 16632022
references: Kidney Int. 2004 Apr;65(4):1492-8
references: 15086493
references: Ren Fail. 2001 Jan;23(1):115-26
references: 11256521
references: Arq Bras Cardiol. 2007 Jun;88(6):643-50
references: 17664991
references: Circulation. 2014 Oct 28;130(18):1607-16
references: 25170097