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Dialysis-Induced Cardiovascular and Multiorgan Morbidity
Hemodialysis has saved many lives, albeit with significant residual mortality. Although poor outcomes may reflect advanced age and comorbid conditions, hemodialysis per se may harm patients, contributing to morbidity and perhaps mortality. Systemic circulatory “stress” resulting from hemodialysis tr...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7609914/ https://www.ncbi.nlm.nih.gov/pubmed/33163709 http://dx.doi.org/10.1016/j.ekir.2020.08.031 |
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author | Canaud, Bernard Kooman, Jeroen P. Selby, Nicholas M. Taal, Maarten W. Francis, Susan Maierhofer, Andreas Kopperschmidt, Pascal Collins, Allan Kotanko, Peter |
author_facet | Canaud, Bernard Kooman, Jeroen P. Selby, Nicholas M. Taal, Maarten W. Francis, Susan Maierhofer, Andreas Kopperschmidt, Pascal Collins, Allan Kotanko, Peter |
author_sort | Canaud, Bernard |
collection | PubMed |
description | Hemodialysis has saved many lives, albeit with significant residual mortality. Although poor outcomes may reflect advanced age and comorbid conditions, hemodialysis per se may harm patients, contributing to morbidity and perhaps mortality. Systemic circulatory “stress” resulting from hemodialysis treatment schedule may act as a disease modifier, resulting in a multiorgan injury superimposed on preexistent comorbidities. New functional intradialytic imaging (i.e., echocardiography, cardiac magnetic resonance imaging [MRI]) and kinetic of specific cardiac biomarkers (i.e., Troponin I) have clearly documented this additional source of end-organ damage. In this context, several factors resulting from patient-hemodialysis interaction and/or patient management have been identified. Intradialytic hypovolemia, hypotensive episodes, hypoxemia, solutes, and electrolyte fluxes as well as cardiac arrhythmias are among the contributing factors to systemic circulatory stress that are induced by hemodialysis. Additionally, these factors contribute to patients’ symptom burden, impair cognitive function, and finally have a negative impact on patients’ perception and quality of life. In this review, we summarize the adverse systemic effects of current intermittent hemodialysis therapy, their pathophysiologic consequences, review the evidence for interventions that are cardioprotective, and explore new approaches that may further reduce the systemic burden of hemodialysis. These include improved biocompatible materials, smart dialysis machines that automatically may control the fluxes of solutes and electrolytes, volume and hemodynamic control, health trackers, and potentially disruptive technologies facilitating a more personalized medicine approach. |
format | Online Article Text |
id | pubmed-7609914 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-76099142020-11-06 Dialysis-Induced Cardiovascular and Multiorgan Morbidity Canaud, Bernard Kooman, Jeroen P. Selby, Nicholas M. Taal, Maarten W. Francis, Susan Maierhofer, Andreas Kopperschmidt, Pascal Collins, Allan Kotanko, Peter Kidney Int Rep Review Hemodialysis has saved many lives, albeit with significant residual mortality. Although poor outcomes may reflect advanced age and comorbid conditions, hemodialysis per se may harm patients, contributing to morbidity and perhaps mortality. Systemic circulatory “stress” resulting from hemodialysis treatment schedule may act as a disease modifier, resulting in a multiorgan injury superimposed on preexistent comorbidities. New functional intradialytic imaging (i.e., echocardiography, cardiac magnetic resonance imaging [MRI]) and kinetic of specific cardiac biomarkers (i.e., Troponin I) have clearly documented this additional source of end-organ damage. In this context, several factors resulting from patient-hemodialysis interaction and/or patient management have been identified. Intradialytic hypovolemia, hypotensive episodes, hypoxemia, solutes, and electrolyte fluxes as well as cardiac arrhythmias are among the contributing factors to systemic circulatory stress that are induced by hemodialysis. Additionally, these factors contribute to patients’ symptom burden, impair cognitive function, and finally have a negative impact on patients’ perception and quality of life. In this review, we summarize the adverse systemic effects of current intermittent hemodialysis therapy, their pathophysiologic consequences, review the evidence for interventions that are cardioprotective, and explore new approaches that may further reduce the systemic burden of hemodialysis. These include improved biocompatible materials, smart dialysis machines that automatically may control the fluxes of solutes and electrolytes, volume and hemodynamic control, health trackers, and potentially disruptive technologies facilitating a more personalized medicine approach. Elsevier 2020-09-09 /pmc/articles/PMC7609914/ /pubmed/33163709 http://dx.doi.org/10.1016/j.ekir.2020.08.031 Text en © 2020 International Society of Nephrology. Published by Elsevier Inc. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Review Canaud, Bernard Kooman, Jeroen P. Selby, Nicholas M. Taal, Maarten W. Francis, Susan Maierhofer, Andreas Kopperschmidt, Pascal Collins, Allan Kotanko, Peter Dialysis-Induced Cardiovascular and Multiorgan Morbidity |
title | Dialysis-Induced Cardiovascular and Multiorgan Morbidity |
title_full | Dialysis-Induced Cardiovascular and Multiorgan Morbidity |
title_fullStr | Dialysis-Induced Cardiovascular and Multiorgan Morbidity |
title_full_unstemmed | Dialysis-Induced Cardiovascular and Multiorgan Morbidity |
title_short | Dialysis-Induced Cardiovascular and Multiorgan Morbidity |
title_sort | dialysis-induced cardiovascular and multiorgan morbidity |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7609914/ https://www.ncbi.nlm.nih.gov/pubmed/33163709 http://dx.doi.org/10.1016/j.ekir.2020.08.031 |
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