Dialysis Patients and Cardiovascular Problems: Can Technology Help Solve the Complex Equation?

Abstract

Patients with end-stage kidney disease undergoing chronic hemodialysis (HD) present higher mortality rates compared with the general population. Once patients are on HD, the risk of cardiovascular death is approximately 30 times higher than in the general population and remains 10–20 times higher after stratification for age, gender, and the presence of diabetes. About half the deaths of patients on dialysis are attributed to cardiovascular causes including coronary heart disease, cerebrovascular disease, peripheral vascular disease, and heart failure. The cardiovascular burden of the HD patient arises from three different sources: risks inherent to the patient and the uremic syndrome, traditional risk factors, and risk factors related to the dialysis therapy. Based on these considerations and the fact that several aspects of the dialysis procedure can either add to the cardiovascular burden or modify the existing burden, new technologies should be directed towards the approach of a potential ‘cardioprotective dialysis therapy’; such an approach may be facilitated by the application of new techniques and advanced dialysis machines. Created to make dialysis easy and safe, new machines feature several options that make patient monitoring and online hemodiafiltration therapy routine procedures. These and other features will possibly make dialysis better tolerated and more efficient in protecting patients from undesirable or potentially fatal cardiovascular events.

The effects of renal replacement therapy on plasma, asymmetric dimethylarginine, nitric oxide and C-reactive protein levels

“…23 Nonetheless, the dialysis population continues to carry an excess mortality from fatal cardiovascular events. 24 We found that plasma ADMA levels were increased by both dialysis treatment and that plasma ADMA levels were negatively correlated with NOx levels. However, the effects of dialysis models on both plasma ADMA and NO are controversial.…”

Effects of Haemodialysis on Circulating Endothelial Progenitor Cell Count

“…A single HD session in itself causes acute cardiovascular stress with multiple effects on the patient ranging from an increase in both cardiac frequency and risk of arrhythmic events to variations in the vascular tone with sudden changes in systemic arterial pressure, and the release of cytokines by the circulating cells that come into contact with the extracorporeal circuit [4,13] . With the above considerations taken as a starting point, and to standardize haemodynamic stress, our patients were treated with haemodiafiltration, a wellknown and highly effective type of dialysis, displaying both diffusion and convection processes, which guarantees a greater biocompatibility and cardiovascular tolerance [14,15] . Thanks to its strategic localization, the endothelium is the first organ to sense mechanical stimuli, such as pressure and shear stress.…”

Risk Factors Associated with Cardiovascular Morbidity and Mortality in Spanish Incident Hemodialysis Patients: Two-Year Results from the ANSWER Study

“…Uremic-related factors include albuminuria, hyperhomocysteinemia, elevated lipoprotein(a), interleukin-6, anemia, abnormal calcium/phosphate metabolism, extracellular fluid volume overload, electrolyte imbalance, oxidative stress, inflammation (C-reactive protein), malnutrition, thrombogenic factors, and altered nitric oxide/endothelin balance [13,14,15,16]. With regard to the dialysis technique, some of the proposed parameters that might modulate the CV risk are: use of high-flux dialyzers, endotoxin filters, hemodiafiltration, non-catheter access type, adequate dialysis doses, and longer or more frequent sessions [17]. …”