Abstract
Cardiovascular disease is the main cause of death among hemodialysis patients. Although uremia by itself may be considered to be a cardiovascular risk factor, a significant proportion of dialysis patients die because of cardiovascular disease not directly attributable to uremia. Indeed, many of the cardiovascular diseases and cardiovascular risk factors in these patients are common to those occurring in the general population and are amenable to intervention. Lack of proper medical care during the early stages of renal insufficiency and present-day dialysis routines, by failing to correct hypertension, hypervolemia and left ventricular hypertrophy in many patients, may also add to the cardiovascular burden. The author suggests that, in addition to early treatment and referral to a specialist, chronic renal failure patients should undergo intensive cardiovascular screening and treatment, and correction of cardiovascular risk factors based on guidelines established for the general population.
Highlights
Cardiovascular disease (CVD) is prevalent in patients with renal failure and accounts for 50% of all dialysis deaths.[1]
Because the classical risk factors included in the Framingham equations fall short in explaining the high prevalence of cardiovascular events among dialysis patients, there has been speculation that this occurs because some alterations that are peculiar to the uremic syndrome are not included in the risk calculations.[10]
Patients with significant coronary artery disease (CAD) had almost ten times higher relative risk of developing events than those with normal coronary arteries or less severe degrees of CAD. Both myocardial scintigraphy and stress echocardiography failed to identify roughly 30% of the patients who developed events. These results suggest that coronary angiography should be performed on all high-risk dialysis patients
Summary
Cardiovascular disease (CVD) is prevalent in patients with renal failure and accounts for 50% of all dialysis deaths.[1]. The personal contribution is based on data from observations of two populations of hemodialysis patients followed up at the author’s institution during the last 10 years: a low-risk group of 120 relatively young patients with low prevalence of comorbidity and a high-risk cohort of 335 subjects who were at least 50 years old and presented diabetes or clinically evident CVD, or both of these (Table 1).[4,5,6,7]. Prompt identification of high-risk patients will result in more successful interventions This is accomplished by identifying individuals with established CVD or those at risk of developing CVD, and calculating the probability of developing cardiovascular events in the future. The latter is usually achieved by applying equations derived from prospective studies in large groups of individuals who were followed up for long periods of time, as described below
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