Cargando…

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...

Descripción completa

Detalles Bibliográficos
Autores principales: Canaud, Bernard, Kooman, Jeroen P., Selby, Nicholas M., Taal, Maarten W., Francis, Susan, Maierhofer, Andreas, Kopperschmidt, Pascal, Collins, Allan, Kotanko, Peter
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2020
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
_version_ 1783605095178436608
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
work_keys_str_mv AT canaudbernard dialysisinducedcardiovascularandmultiorganmorbidity
AT koomanjeroenp dialysisinducedcardiovascularandmultiorganmorbidity
AT selbynicholasm dialysisinducedcardiovascularandmultiorganmorbidity
AT taalmaartenw dialysisinducedcardiovascularandmultiorganmorbidity
AT francissusan dialysisinducedcardiovascularandmultiorganmorbidity
AT maierhoferandreas dialysisinducedcardiovascularandmultiorganmorbidity
AT kopperschmidtpascal dialysisinducedcardiovascularandmultiorganmorbidity
AT collinsallan dialysisinducedcardiovascularandmultiorganmorbidity
AT kotankopeter dialysisinducedcardiovascularandmultiorganmorbidity