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2016 ; 25
(6
): 536-544
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Cardiovascular complications in chronic dialysis patients
#MMPMID27636771
Mavrakanas TA
; Charytan DM
Curr Opin Nephrol Hypertens
2016[Nov]; 25
(6
): 536-544
PMID27636771
show ga
PURPOSE OF REVIEW: This review article focuses on the most significant
cardiovascular complications in dialysis patients [sudden cardiac death (SCD),
acute coronary syndromes, heart failure, and atrial fibrillation]. RECENT
FINDINGS: Current and ongoing research aims to quantify the rate and pattern of
significant arrhythmia in dialysis patients and to determine the predominant
mechanism of SCD. Preliminary findings from these studies suggest a high rate of
atrial fibrillation and that bradycardia and asystole may be more frequent than
ventricular arrhythmia as a cause of sudden death. A recently published matched
cohort study in dialysis patients who received a defibrillator for primary
prevention showed that there was no significant difference in mortality rates
between defibrillator-treated patients and propensity-matched controls. Two
randomized controlled trials are currently recruiting participants and will
hopefully answer the question of whether implantable or wearable cardioverter
defibrillators can prevent SCD. An observational study using United States Renal
Data System data demonstrated how difficult it is to keep hemodialysis patients
on warfarin, as more than two-thirds discontinued the drug during the first year.
The ISCHEMIA-CKD trial may provide answers about the optimal strategy for the
treatment of atherosclerotic coronary disease in patients with advanced chronic
kidney disease. SUMMARY: The article reviews the diagnosis of acute coronary
syndromes in dialysis patients, current literature on myocardial
revascularization, and data on fatal and nonfatal cardiac arrhythmia. The new
classification of heart failure in end-stage renal disease is reviewed. Finally,
available cohort studies on warfarin for stroke prevention in dialysis patients
with atrial fibrillation are reviewed.