Cardiovascular Disease in End Stage Renal Disease Patients

Abstract

Cardiovascular disease is the primary cause of preventable death in industrialized countries (1). It is on a steady rise in many other countries where it had not been traditionally recognized as a major disease burden. There has been a lot of attempts to define the risk factors associated with cardiovascular disease. Similar efforts have been made in defining the treatment and the secondary prevention of cardiovascular diseases. End Stage Renal Disease (ESRD) patients form a vulnerable sub-group of general population. In 2007, the adjusted annual mortality of dialysis patients in the United States was 19 % (USRDS 2008 Annual Data Report) (2). Cardiovascular and infection related complications are the major cause of morbidity and mortality in this group (3). ESRD patients have a high prevalence of cardiovascular risk factors leading to a phenomenally high cardiovascular morbidity and mortality. In fact it remains the single most important cause of death in ESRD patients. In 2005-2007 it accounted for 45 % of all deaths in ESRD patients (4). Cardiac arrest was responsible for almost half of these deaths (5). This apparently disproportionate burden of cardiovascular disease in ESRD patients is likely due to the many traditional risk factors that both these diseases share. In addition, we are learning more about other non-conventional risk factors unique to ESRD patients that promote and accelerate the atherosclerotic process that underlies most cardiovascular diseases. In this chapter we will discuss the significant risk factors of cardiovascular diseases in ESRD patients. We will also discuss the treatment and intervention aspects of cardiovascular disease, especially in reference to hemodialysis patients.