Recurrent circulatory stress: the dark side of dialysis

Area of Science:

• Nephrology
• Cardiovascular Medicine
• Pathophysiology

Background:

• Conventional hemodialysis (HD) is an industrialized process with overlooked iatrogenic effects.
• HD imposes significant recurrent systemic circulatory stress.
• This stress is implicated in cardiac disease and may cause perfusion-dependent injury in other organs like the gut, brain, and kidneys.

Discussion:

• Dialysis-induced hemodynamic injury can lead to direct perfusion damage.
• It may also trigger local and systemic inflammation.
• These factors can potentiate further cycles of injury, creating a detrimental feedback loop.

Key Insights:

• A pathophysiological paradigm is proposed where dialysis-induced acute injury is central to the disease burden in HD patients.
• Vulnerable vascular beds, including the gut, brain, and kidneys, are susceptible to perfusion-dependent injury.
• The interplay of hemodynamic stress, inflammation, and injury cycles contributes to uremic-related disease states.

Outlook:

• Further research into the mechanisms of dialysis-induced injury is warranted.
• Developing strategies to mitigate hemodynamic stress during HD could improve patient outcomes.
• Rethinking HD protocols to minimize iatrogenic harm is crucial for managing uremic disease.