Related Experiment Video
Updated: Mar 16, 2026
Pre-clinical Model of Cardiac Donation after Circulatory Death
Published on: August 2, 2019
An Update on Intradialytic Cardiac Dysfunction
Aghogho Odudu1,2, Christopher W McIntyre3
1Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom. a.odudu@manchester.ac.uk.
Insights
Hemodialysis (HD) patients experience cardiac dysfunction, leading to high mortality. Strategies targeting intradialytic cardiac issues may prevent heart failure and improve quality of life.
Area of Science:
- Cardiology
- Nephrology
- Vascular Biology
Background:
- Cardiac dysfunction is a major cause of mortality in hemodialysis (HD) patients, often manifesting as structural changes before dialysis initiation.
- Adverse vascular remodeling in HD patients results from dysregulated signaling pathways influenced by hemodynamic and nonhemodynamic factors.
- The HD procedure itself exacerbates cardiac issues through hypotension and ischemia, leading to fibrosis, worsening symptoms, and increased mortality.
Purpose of the Study:
- To review the evidence for intradialytic cardiac dysfunction in hemodialysis patients.
- To outline cardioprotective strategies targeting intradialytic cardiac dysfunction.
- To explore the potential impact of these strategies on multiple organ systems and patient quality of life.
Main Methods:
- Review of existing literature on cardiac dysfunction in hemodialysis.
- Analysis of the impact of the hemodialysis procedure on cardiac and vascular structures.
- Discussion of novel imaging techniques for assessing physiological responses during HD.
- Exploration of therapeutic strategies targeting intradialytic factors.
Main Results:
- Drug-based therapies have shown limited success in reversing HD-associated cardiomyopathy due to single-pathway targeting.
- Intradialytic interventions (dialysate temperature, composition, ultrafiltration rate) show promise in preventing global cardiomyopathy.
- Novel imaging techniques can characterize the physiological response to HD, a model of ischemia-reperfusion injury.
Conclusions:
- Reducing HD-associated cardiomyopathy requires a paradigm shift towards personalized therapy balancing fluid/solute removal with microvascular protection.
- Targeting intradialytic cardiac dysfunction may prevent heart failure, improve exercise tolerance, sleep, cognitive function, and overall quality of life.
- Further research is needed to establish the natural history and prioritize clinical trials for HD-associated cardiomyopathy.
Abstract:
Cardiac dysfunction is a key factor in the high morbidity and mortality rates seen in hemodialysis (HD) patients. Much of the dysfunction is manifest as adverse changes in cardiac and vascular structure prior to commencing dialysis. This adverse vascular remodeling arises as a dysregulation between pro- and antiproliferative signaling pathways in response to hemodynamic and nonhemodynamic factors. The HD procedure itself further promotes cardiomyopathy by inducing hypotension and episodic regional cardiac ischemia that precedes global dysfunction, fibrosis, worsening symptoms, and increased mortality. Drug-based therapies have been largely ineffective in reversing HD-associated cardiomyopathy, in part due to targeting single pathways of low yield. Few studies have sought to establish natural history and there is no framework of priorities for future clinical trials. Targeting intradialytic cardiac dysfunction by altering dialysate temperature, composition, or ultrafiltration rate might prevent the development of global cardiomyopathy, heart failure, and mortality through multiple pathways. Novel imaging techniques show promise in characterizing the physiological response to HD that is a unique model of repetitive ischemia-reperfusion injury. Reducing HD-associated cardiomyopathy may need a paradigm shift from empirical delivery of solute clearance to a personalized therapy balancing solute and fluid removal with microvascular protection. This review describes the evidence for intradialytic cardiac dysfunction outlining cardioprotective strategies that extend to multiple organs with potential impacts on exercise tolerance, sleep, cognitive function, and quality of life.
More Related Videos
07:52A Mouse 5/6th Nephrectomy Model That Induces Experimental Uremic Cardiomyopathy
Published on: November 7, 2017
12:45Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
Published on: December 11, 2017
Related Concept Videos
01:22Heart Failure Drugs: Diuretics
01:30Cardiomyopathy II: Dilated Cardiomyopathy
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:22Heart Failure VI: Adjunct Therapies
01:24Hemodialysis II: Procedure and Complications
01:18Chronic Kidney Disease IV: Nursing Management