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| UDK 616.61-78-06 616.1-084 COBISS.SR-ID 214706700 |
ISSN 0350-2899, 40(2015) br. 1, p.20-27 |
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Review article Hemodialysis-associated cardiomyopathy: etiopathogenesis, diagnosis and treatment Kardiomiopatija povezana sa hemodijalizom: etiopatogeneza, dijagnostika i lečenje Dejan Petrović (1, 3), Biserka Tirmenštajn Janković (2), Milenko Živanović (2), Mina Poskurica (3), Julija Marjanović (3), Milan Radovanović (4) (1) Klinika za urologiju i nefrologiju, KC Kragujevac, Kragujevac, (2) Odeljenje za hemodijalizu, Zdravstveni centar „Zaječar”, Zaječar, (3) Fakultet medicinskih nauka Univerziteta u Kragujevcu, Kragujevac, (4) Klinika za kardiologiju, KC Kragujevac, Kragujevac |
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| Download in pdf format | Summary: Cardiovascular diseases are the leading cause of death in patients treated with hemodialysis. Hemodialysis leads to ischemia and myocardial stunning, and the consequence of that is the development of systolic heart failure and sudden cardiac death. Patients treated with hemodialysis are at high risk of myocardial ischemia due to reduced coronary flow reserve (left ventricular hypertrophy, coronary artery atherosclerosis, intramyocardial small vessel disease, myocardial interstitial fibrosis, peripheral artery disease). The most important risk factors for the development of cardiomyopathy associated with hemodialysis are an excessive ultrafiltration (> 10 ml/kg/h) and intradialytic hypotension. In circumstances of excessive ultrafiltration and/or hypotension, intradialytic ischemia and reperfusion occur. Repeated episodes of ischemia and reperfusion lead to the reshaping of the structure and function of the left ventricle, the development of systolic heart failure and sudden cardiac death. In patients with left ventricular regional wall motion abnormalities registered by ultrasound examination during hemodialysis and regional myocardial perfusion abnormalities assessed by positron emission tomography, the development of systolic heart failure can be observed after 12 months. Therapeutic procedures include: preservation of residual renal function, optimal control of cardiovascular risk factors, individualization of hemodialysis (optimal rate of ultrafiltration, prolonged hemodialysis, increased frequency of hemodialysis, a cold solution for hemodialysis, adjusting the concentration of sodium and calcium in solution for hemodialysis, use of vasopressors), hemodiafiltration and new modalities of dialysis (BFD - biofeedback dialysis). Myocardial ischemia during hemodialysis can be prevented, and this contributes to the reduction of cardiovascular morbidity and mortality in patients treated with hemodialysis. Key words: risk factors, cardiomyopathy, hemodialysis, ultrafiltration Napomena: kompletan tekst rada na srpskom jeziku Note: full text in Serbian |
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Corresponding Address: Slobodan Savović, Dejan Petrović Klinika za urologiju i nefrologiju, Klinički Centar Kragujevac; Zmaj Jovina 30, 34000 Kragujevac; Srbija; E-mail: dejanpetrovic68@sbb.rs |
Paper received: 12.1.2015 Paper accepted: 24.1.2015 Paper Internet issues: 20.6.2014 |
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