Hemodynamic Cardiovascular Risk Factors in Chronic Kidney Disease

What are the Effects of Intervention?

McMahon, Lawrence P.

Department of Nephrology, Royal Melbourne and Western Hospitals, Melbourne, Victoria, Australia

Address correspondence to: Lawrence McMahon, MD, Department of Nephrology, Royal Melbourne and Western Hospitals, Melbourne 3050, Victoria, Australia, or e-mail: [email protected].

Seminars in Dialysis 16(2):p 128-139, March-April 2003.

Left ventricular (LV) volume and pressure overload occur frequently in chronic kidney disease (CKD). Anemia is a risk factor for left ventricular hypertrophy (LVH) and dilatation, heart failure, and death. Normalization of hemoglobin with erythropoietin may prevent LVH and dilatation in CKD, but in patients in later phases of their cardiac disease, this intervention is not of benefit. Increased vascular volume causes hypertension, which in turn causes LVH, cardiac failure, and ischemic heart disease (IHD). Manifestations of arteriosclerosis are associated with adverse cardiac outcomes, and angiotensin converting enzyme (ACE) inhibitors may improve LVH and markers of arteriosclerosis. Aortic stenosis in dialysis patients occurs infrequently, but may deteriorate rapidly. The hemodialysis milieu is the quintessential model of LV overload cardiomyopathy.