A Personalized Approach to Chronic Kidney Disease and Cardiovascular Disease: JACC Review Topic of the Week.
J Am Coll Cardiol
; 77(11): 1470-1479, 2021 03 23.
Article
in En
| MEDLINE
| ID: mdl-33736830
ABSTRACT
Cardiovascular disease is the most common cause of death in patients with end-stage renal disease (ESRD). The initiation of dialysis for treatment of ESRD exacerbates chronic electrolyte and hemodynamic perturbations. Rapid large shifts in effective intravascular volume and electrolyte concentrations ultimately lead to subendocardial ischemia, increased left ventricular wall mass, and diastolic dysfunction, and can precipitate serious arrhythmias through a complex pathophysiological process. These factors, unique to advanced kidney disease and its treatment, increase the overall incidence of acute coronary syndrome and sudden cardiac death. To date, risk prediction models largely fail to incorporate the observed cardiovascular mortality in the CKD population; however, multimodality imaging may provide an additional prognostication and risk stratification. This comprehensive review discusses the cardiovascular risks associated with hemodialysis, and explores the pathophysiology and the novel utilization of multimodality imaging in CKD to promote a personalized approach for these patients with implications for future research.
Key words
Full text:
1
Database:
MEDLINE
Main subject:
Cardiovascular Diseases
/
Renal Dialysis
/
Multimodal Imaging
/
Kidney Failure, Chronic
Type of study:
Diagnostic_studies
/
Etiology_studies
/
Prognostic_studies
Limits:
Humans
Language:
En
Journal:
J Am Coll Cardiol
Year:
2021
Type:
Article
Affiliation country:
United States