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Assessment of Vascular Function in Patients With Chronic Kidney Disease
08:50

Assessment of Vascular Function in Patients With Chronic Kidney Disease

Published on: June 16, 2014

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[Congestive heart failure in patients with chronic kidney disease]

Mileta Poskurica, Dejan Petrović

    Srpski Arhiv Za Celokupno Lekarstvo
    |March 4, 2015
    PubMed

    Insights

    Cardiovascular disorders are a leading cause of death in chronic renal failure (CRF) patients on dialysis. Managing heart failure in these patients involves standard therapies and dialysis techniques to control fluid overload.

    Area of Science:

    • Nephrology
    • Cardiology
    • Internal Medicine

    Background:

    • Cardiovascular disorders cause 46-60% of deaths in advanced chronic renal failure (CRF) patients undergoing dialysis.
    • Uremic cardiomyopathy, ischemic heart disease (IHD), and anemia are key contributors to congestive heart failure (CHF) in this population.
    • Specific risk factors associated with kidney failure and dialysis exacerbate these cardiac issues.

    Purpose of the Study:

    • To review the pathophysiology, diagnosis, and management of cardiovascular disorders in patients with advanced chronic renal failure on dialysis.
    • To highlight the challenges in diagnosing heart failure due to unreliable biohumoral markers in CRF patients.
    • To discuss current therapeutic strategies, including dialysis-based fluid management and specific cardiac interventions.

    Main Methods:

    • Review of existing literature on cardiovascular complications in CRF patients.
    • Analysis of diagnostic methods for congestive heart failure (CHF) in dialysis patients.
    • Evaluation of therapeutic approaches, including pharmacological treatments and dialysis modalities.

    Main Results:

    • Congestive heart failure (CHF) is a common and serious complication in dialysis patients, driven by uremic cardiomyopathy, IHD, and anemia.
    • Diagnosis relies on clinical assessment, ECG, echocardiography, and radiology, as biohumoral markers like BNP are less reliable.
    • Fluid management through ultrafiltration during hemodialysis/hemodiafiltration and peritoneal dialysis is crucial for controlling hypervolemia.

    Conclusions:

    • Cardiovascular disease management in CRF patients requires a multi-faceted approach, integrating standard cardiac therapies with dialysis techniques.
    • Revascularization procedures are beneficial for associated IHD, while cardiac resynchronization and defibrillator implantation may be considered in selected cases.
    • Effective management of fluid balance is paramount in preventing and treating heart failure in patients with advanced chronic renal failure.

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