Hemodialysis and heart: more questions than answers
Abstract
Modern data on cardiovascular (CV) morbidity and mortality in patients on chronic hemodialysis (CHD) are described. According to published data, approximately one of five patients die by the end of the first year of CHD. High CV mortality of dialysis population is a consequence of a combination of traditional and non-traditional risk factors. Non-traditional risk factors are represented by set of toxico-metabolic and hemodynamic effects of renal damage load on myocardium and CHD per se. For a cardiologist, CHD-associated CV risk factors are the subject of particular interest. Among them hemodynamic syndialysis stress, CHD-induced myocardial ischemia, overload, intra/post-dialysis hypotension, high output heart failure and dynamic intraventricular obstruction should be mentioned. All these phenomena cause direct myocardial injury and aggravation of heart failure. The problems listed dictate the need to develop a definite methodology of an initial assessment and follow up of cardiac status of CHD-patients. Authors propose interdisciplinary approaches to the above-mentioned problems.
About the Authors
E. M. Zeltyn-Abramov
Pirogov Russian National Research Medical University (RNRMU); Moscow City Hospital 52
Russian Federation
Russian Federation
N. G. Potheshkina
Pirogov Russian National Research Medical University (RNRMU)
Russian Federation
Russian Federation
A. M. Andrusev
A.I. Evdokimov Moscow State University of Medicine and Dentistry; Moscow City Hospital 52
Russian Federation
Russian Federation
N. I. Belavina
Moscow City Hospital 52
Russian Federation
Russian Federation
N. V. Sokolova
Moscow City Hospital 52
Russian Federation
Russian Federation
References
1. Бикбов Б. Т., Томилина Н. А. Факторы риска смерти больных, впервые начинающих лечение гемодиализом (по данным Регистра Российского диализного общества). Нефрология и диализ. 2008. 10(1): 35-43.
2. Бикбов Б.Т., Томилина Н.А. Заместительная терапия больных с хронической почечной недостаточностью в Российской Федерации в 1998-2011 гг. (Отчет по данным Российского регистра заместительной почечной терапии. Часть первая). Нефрология и диализ. 2014. 16(1): 11-127.
3. Бикбов Б.Т., Томилина Н.А. Состояние заместительной терапии больных с хронической почечной недостаточностью в Российской Федерации в 1998-2005 гг. Нефрология и диализ, 2007. 9(1): 6-85.
4. Дудко М. Ю., Шутов Е. В., Капитанов Е. Н., Ермоленко В. М. Влияние нарушений водного баланса на состояние сердечно-сосудистой системы у больных на заместительной почечной терапии. Нефрология и диализ. 2006. 8(3): 244-249.
5. Ильин А. П., Богоявленский В. Ф., Газизов Р. М., Полетаев И. В. Дисфункция миокарда у больных ХПН в возрасте старше 55 лет, находящихся на программном гемодиализе: Особенности диастолической и систолической дисфункции гипертрофированного миокарда и влияние процедуры гемодиализа на показатели гемодинамики. Нефрология и диализ. 2001. 3(3): 365-369.
6. Короткий Д. В., Макеева Т. И., Заварицкая О. П., Земченков А. Ю. Артериальная гипертензия и гипертрофия миокарда на преддиализной стадии хронической болезни почек и при заместительной почечной терапии. Нефрология и диализ. 2009. 11(3): 251-257.
7. Строков А.Г. Терехов В.А. Гаврилин В.А. и соавт. Интрадиализная артериальная гипотензия и ее профилактика при помощи мониторинга относительного объема крови. Нефрология и диализ. 2010. 12(4): 250-253.
8. Шарра Б. Гемодиализ: «сухой вес». история концепции. Нефрология и диализ. 1999. 1(2,3): 181-185.
9. Шутов A. M., Мастыков В. Э., Едигарова О. М. Диастолическая дисфункция и интрадиализная гипотензия. Нефрология и диализ. 2003. 5(2): 156-160.
10. Шутов A. M., Мастыков В. Э., Едигарова О. М. Хроническая сердечная недостаточность у больных с хронической болезнью почек. Нефрология и диализ. 2005. 7(2): 140-144.
11. Шутов А. М., Едиганова О. М., Мастыков В. Э. Оценка массы миокарда левого желудочка у больных на программном гемодиализе. Нефрология и диализ. 2004. 6(2): 177-180.
12. Assa S., Hummel Y.M., Voors A.A. et al. Hemodialysis-induced regional left ventricular systolic dysfunction: prevalence, patient and dialysis treatment-related factors, and prognostic significance. Clin J Am Soc Nephrol. 2012. 7: 1615-1623.
13. Baigent C., Burbury K., Wheeler D. Premature cardiovascular disease in chronic renal failure. Lancet. 2000. 356: 147-152.
14. Bradbury B.D., Fissell R.B., Albert J.M. et al. Predictors of early mortality among incident US hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Clin J Am Soc Nephrol. 2007. 2: 89-99.
15. Briet M., Boutouyrie P., Laurent S. et al. Arterial stiffness and pulse pressure in CKD and ESRD. Kidney Int. 2012. 82: 388-400.
16. Broers N.J., Cuijpers A.C., van der Sande F.M. et al. The first year on haemodialysis: a critical transition. Clin Kidney J. 2015 Jun. 8(3): 271-277.
17. Burton J.O., Jefferies H.J., Selby N.M. et al. Hemodialysis-induced repetitive myocardial injury results in global and segmental reduction in systolic cardiac function. Clin J Am Soc Nephrol. 2009. 4: 1925-1931.
18. Chang T.I., Friedman G.D., Green T. et al. Systolic blood pressure and mortality in prevalent haemodialysis patients in the HEMO study. J Hum Hypertens. 2011. 25(2): 98-105.
19. Cheung A.K., Sarnak M.J., Yan G. et al. HEMO Study Group: Cardiac diseases in maintenance hemodialysis patients: Results of the HEMO Study. Kidney Int 2004. 65: 2380-2389.
20. Chia-Ter Chao, Jenq-Wen Huang, Chung-Jen Yen. Intradialytic Hypotension and Cardiac Remodeling: A Vicious Cycle. BioMed Res Int. 01/2015. 2015:1-7.
21. de Jager D.J., Grootendorst D.C., Jager K.J. et al. Cardiovascular and noncardiovascular mortality among patients starting dialysis. JAMA. 2009. 302: 1782-1789.
22. Endemann D.H., Schiffrin E.L. Endothelial dysfunction. J Am Soc Nephrol. 2004. 15: 1983-1992.
23. ERA-EDTA registry. Annual Report 2013. Available at: http://www.era-edta-reg.org/index.
24. ESRD Patients in 2013. A Global Perspective. Available at: http://www.vision-fmc.com.
25. Fellistrom B.C., Jardine A.G., Schmieder R.E. et al. Rosuvastatin and Cardiovascular Events in Patients Undergoing Hemodialysis. N Engl Med. 2009. 360: 1396-1407.
26. Foley R.N., Parfrey P.S., Sarnak M.J. Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis. 1998. 32: S112-S119.
27. Fort J. Chronic renal failure: a cardiovascular risk factor. Kidney Int Suppl. 2005. (99): S25-S29.
28. Franczyk-Skóra B., Gluba A., Banach M. et al. Prevention of sudden cardiac death in patients with chronic kidney disease. BMC Nephrol. 2012. 13: 162.
29. Green D., Roberts P.R., New D.I. et al. Sudden cardiac death in hemodialysis patients: an in-depth review. Am J Kidney Dis. 2011. 57: 921-929.
30. Harnett J.D., Foley R.N., Kent G.M. et al. Congestive heart failure in dialysis patients: prevalence, incidence, prognosis and risk factors. Kidney Int. 1995. 47: 884-890.
31. Hopkins K., Bakris G.L. Hypertension Goals in Advanced-Stage Kidney Disease Clin J Am SocNephrol. Dec 2009. 4 Suppl 1: S92-94.
32. Hung S.C., Kuo K.L., Peng C.H. et al. Volume overload correlates with cardiovascular risk factors in patients with chronic kidney disease. Kidney Int. 2014. 85: 703-709.
33. Jaber B.L. Bacterial infections in hemodialysis patients: pathogenesis and prevention. Kidney Int. 2005. 67: 2508-2519.
34. Jardine A.G., Gaston R.S., Fellstrom BC et al. Prevention of cardiovascular disease in adult recipients of kidney transplants. Lancet. 2011. 378: 1419-1427.
35. Kalantar-Zadeh K., Block G., Humphreys M. et al. Reverse epidemiology of cardiovascular risk factors in maintenance dialysis patients. Kidney Int. 2003. 63: 793-808.
36. Konings C.J., Kooman J.P., Schonck M. et al. Fluid status, blood pressure, and cardiovascular abnormalities in patients on peritoneal dialysis. Perit Dial Int. 2002. 22: 477-487.
37. Kumar S., Bogle R., Banerjee D. Why do young people with chronic kidney disease die early? World J Nephrol. 2014 Nov 6. 3(4): 143-155.
38. MacRae J.M., Pandeya S., Humen D.P. et al. Arteriovenous fistula-associated high-output cardiac failure: a review of mechanisms. Am J Kidney Dis. 2004. 43: e17-e22.
39. Mancia G., Fagard R., Narkiewicz K. et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension European Heart Journal. 2013. 34: 2159-2219.
40. Mangrum J., Lin D., Dimarco J. et al. Prognostic value of left ventricular systolic function in renal dialysis patients. Heart Rhythm. 2006. 3: 154-154.
41. Mark P.B., Johnston N., Groenning B.A. et al. Redefinition of uremic cardiomyopathy by contrast-enhanced cardiac magnetic resonance imaging. Kidney Int. 2006. 69: 1839-1845.
42. McCullough P.A., Kellum J.A., Haase M. et al. Pathophysiology of the Cardiorenal Syndromes: Executive Summary from the Eleventh Consensus Conference of the Acute Dialysis Quality Initiative (ADQI). Blood Purif. 2014. 37 Suppl 2: 2-13.
43. Neovius M., Jacobson S.H., Eriksson J.K. et al. Mortality in chronic kidney disease and renal replacement therapy: a population-based cohort study. BMJ Open. 2014. 4: e004251.
44. Noordzij M., Jager K.J. Increased mortality early after dialysis initiation: a universal phenomenon. Kidney Int. 2014. 85: 12-14.
45. Parfrey P.S., Foley R.N. The clinical epidemiology of cardiac disease in chronic renal failure. J Am SocNephrol. 1999. 10: 1606-1615.
46. Peev V., Nayer A., Contreras G. Dyslipidemia, malnutrition, inflammation, cardiovascular disease and mortality in chronic kidney disease. Curr Opin Lipidol. 2014. 25: 54-60.
47. Poulikakos D, Banerjee D, Malik M. Risk of Sudden Cardiac Death in Chronic Kidney Disease. J Cardiovasc Electrophysiol. 2014 Feb. 25 (2): 222-231.
48. Ramasubbu K., Deswal A., Herdejurgen C. et al. A prospective echocardiographic evaluation of pulmonary hypertension in chronic hemodialysis patients in the United States: prevalence and clinical significance. Int J Gen Med. 2010. 3: 279-286.
49. Rhodes J., Shiller M.S., Tejani A. et al. Hemodialysis-induced subaortic obstruction in asymmetric septal hypertrophy. Am Heart J. 1992. 123: 807-810.
50. Robinson B.M., Zhang J., Morgenstern H. et al. Worldwide, mortality risk is high soon after initiation of hemodialysis. Kidney Int. 2014. 85: 158-165.
51. Segall L., Nistor I. et al. Heart failure in patients with chronic kidney disease: a systematic integrative review. Biomed Res Int. 2014. May: 937398.
52. Shishehbor M.H., Oliveira L.P., Lauer M.S. et al. Emerging cardiovascular risk factors that account for a significant portion of attributable mortality risk in chronic kidney disease. Am J Cardiol. 2008. 101: 1741-1746.
53. Singh A.K., Szezech L., Tang K.l. et al. Correction of anemia with epoetin alfa in chronic kidney disease. New Engl J Med. 2006. 355(20): 2085-2098.
54. Sipahioglu M.H., Usvyat L., Liu L. et al. Early systolic blood pressure changes in incident hemodialysis patients are associated with mortality in the first year. Kidney Blood Press Res. 2012. 35: 663-670.
55. Soucie J.M., McClellan W.M. Early death in dialysis patients: risk factors and impact on incidence and mortality rates. J Am SocNephrol. 1996. 7: 2169-2175.
56. Steenkamp R., Shaw C., Feest T. UK Renal Registry 15th annual report: Chapter 5 survival and causes of death of UK adult patients on renal replacement therapy in 2011: national and centre-specific analyses. Nephron ClinPract. 2013. 123. Suppl 1: 93-123.
57. Strippoli G.F.M., Craig J.C. Sunset for Statins after AVRORA? N Engl Med. 2009. 360: 1455-1457.
58. Tong A., Manns B., Hemmelgarn B. et al. Standardised outcomes in nephrology - Haemodialysis (SONG-HD): study protocol for establishing a core outcome set in haemodialysis. Trials. 2015. 16(1): 364.
59. United States Renal Data System: Annual Data Report, 2015. Available at: http://www.usrds.org/adr.aspx.
60. United States Renal Data System: Archived Reports. Available at: http://www.usrds.org/archive.aspx.
61. Wizemann V., Wabel P., Chamney P. et al. The mortality risk of overhydration in haemodialysis patients. Nephrol Dial Transplant. 2009. 24: 1574-1579.
62. Yigla M., Fruchter O., Aharonson D. et al. Pulmonary hypertension is an independent predictor of mortality in hemodialysis patients. Kidney Int. 2009. 75: 969-975.
63. Zipes D.P., Camm A.J., Borggrefe M. et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Circulation. 2006. 114: 385-484.
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For citations:
Zeltyn-Abramov E.M., Potheshkina N.G., Andrusev A.M., Belavina N.I., Sokolova N.V. Hemodialysis and heart: more questions than answers. Nephrology and Dialysis. 2016;18(1):69-75. (In Russ.)
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