[Cardiomyopathy in uremia: hemodynamic and metabolic aspects (author's transl)]

Precise determination of myocardial function in chronic renal failure is difficult because of the fluctuation of parameters especially in those patients undergoing intermittent hemodialysis. Reliable methods of investigation should be used to correctly evaluate possible functional abnormalities. Results of our study and of several other publications prove that some hemodialysis patients have a congestive cardiomyopathy (non obstructive) which is likely to be in relation with uremia. Several factors have been suggested in the literature to explain the etiology and pathogenesis of uremic cardiomyopathy. Disturbed metabolism of phosphate and calcium associated with the hyperparathyroidism of renal failure has been observed both in laboratory animals and patients with uremia. Altered metabolism of lipids associated with carnitine deficiency might also play a role. More thorough methods of investigation and additional experimental studies, both in vitro and in vivo are called for in order to define myocardial dysfunction in chronic renal failure. This should provide a basis for improved prevention and treatment of uremic cardiomyopathy.