Evidence-Based Cardiology in Hemodialysis Patients

Abstract

Cardiac events are the major cause of death in hemodialysis patients. Because of the paucity of randomized clinical trials (RCTs) in hemodialysis patients, most cardiovascular therapies in this population are based on observational studies or results extrapolated from studies that excluded hemodialysis patients. However, associations discovered in observational studies do not prove causality, and these studies often report surrogate outcomes rather than clinical end points. Furthermore, interventions that show effectiveness in the general population may have drastically different outcomes and side effect profiles in hemodialysis patients. This review discusses the results of RCTs undertaken recently to evaluate cardiovascular therapies in hemodialysis patients and emphasizes clinically relevant outcomes. Although some interventions have produced similar outcomes in hemodialysis patients and the general population, others have not, suggesting that the management of cardiovascular disease in hemodialysis patients may require strategies that differ from the best practice guidelines applied to general population.

The effect of two different high-flux dialysis membranes on insulin resistance in non-diabetic end-stage renal disease patients

“…[19][20][21] Studies showed that high-flux membranes are better than low-flux membranes in terms of reducing insulin resistance and cardiovascular mortality and morbidity. [22][23][24] With recent developments in dialysis technology, the inflammation caused by HD is observed less frequently with biologically adaptive membranes; uremic toxins, medium and large molecules are better cleaned; and hyperlipidemia and oxidative stress are observed less frequently.…”

Effect of cardiovascular risk factors and time of hospital presentation on mortality of maintenance hemodialysis patients presenting with acute pulmonary edema

“…The number of patients on maintenance hemodialysis suffering from end-stage renal disease (ESRD) is approximately 400,000 in the USA [1] and approximately 300,000 in Japan [2]. Cardiovascular disease accounts for 50% of death among these patients [3], with congestive heart failure comprising approximately 25% of death in Japan [2].…”

“…Patients with ESRD on maintenance hemodialysis should be considered as different from the general population because they have different cardiovascular disease characteristics and responses to therapy [1,3]. Moreover, periodic hemodialysis therapy jeopardizes their preload to fluctuate non-physiologically.…”

Impact of the Number of Anti-Thrombosis Agents in Hemodialysis Patients: BOREAS-HD2 Study

“…Because of substantial differences between the clinical profiles of patients with ESRD and those without ESRD [8], the benefit-risk ratios are presumably different in these two groups. However, there have been only a few studies in which relationships between the number of anti-thrombosis (AP and/or anti-coagulant) agents, clinical benefits and adverse events including major hemorrhage were examined [9, 10].…”