The heart and vascular system in dialysis

Wanner C, Amann KU, Shoji T (2016)

Publication Type: Journal article

Publication year: 2016

Journal

Lancet Elsevier: Lancet

Book Volume: 388

Pages Range: 276-84

Journal Issue: 10041

DOI: 10.1016/S0140-6736(16)30508-6

Abstract

The heart and the vascular tree undergo major structural and functional changes when kidney function declines and renal replacement therapy is required. The many cardiovascular risk factors and adaptive changes the heart undergoes include left ventricular hypertrophy and dilatation with concomitant systolic and diastolic dysfunction. Myocardial fibrosis is the consequence of impaired angio-adaptation, reduced capillary angiogenesis, myocyte-capillary mismatch, and myocardial micro-arteriopathy. The vascular tree can be affected by both atherosclerosis and arteriosclerosis with both lipid rich plaques and abundant media calcification. Development of cardiac and vascular disease is rapid, especially in young patients, and the phenotype resembles all aspects of an accelerated ageing process and latent cardiac failure. The major cause of left ventricular hypertrophy and failure and the most common problem directly affecting myocardial function is fluid overload and, usually, hypertension. In situations of stress, such as intradialytic hypotension and hypoxaemia, the hearts of these patients are more vulnerable to developing cardiac arrest, especially when such episodes occur frequently. As a result, cardiac and vascular mortality are several times higher in dialysis patients than in the general population. Trials investigating one pharmacological intervention (eg, statins) have shown limitations. Pragmatic designs for large trials on cardio-active interventions are mandatory for adequate cardioprotective renal replacement therapy.

Authors with CRIS profile

Kerstin Ute Amann Department of Nephropathology

Involved external institutions

Osaka City University (OCU) / 大阪市立大学 JP Japan (JP) Universitätsklinikum Würzburg DE Germany (DE)

How to cite

APA:

Wanner, C., Amann, K.U., & Shoji, T. (2016). The heart and vascular system in dialysis. Lancet, 388(10041), 276-84. https://doi.org/10.1016/S0140-6736(16)30508-6

MLA:

Wanner, Christoph, Kerstin Ute Amann, and Tetsuo Shoji. "The heart and vascular system in dialysis." Lancet 388.10041 (2016): 276-84.

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