Cardiovascular complications in end-stage renal disease and hemodialysis patients

The frequency of cardiovascular diseases in patients with end-stage renal disease (ESRD) is high, since hypotension, hyperlipidemia, advanced age, diabetes and other systemic diseases that may affect the heart are common in such patients. In addition to the pre-existing factors for cardiovascular disease, there are also predisposing factors that relate specifically to life on hemodialysis (HD). These include myocardial stress related to recurrent volume expansion and contraction, anemia, secondary hyperparathyroidism, excess or deficit of certain trace metals that may act as enzyme cofactors, and factors that inhibit myocardial ATPase. The prevalence, pathogenesis, and significance of these factors in ESRD patients are examined, and the potential roles of management are reviewed.