Cardiovascular disease in end-stage renal disease: the challenge of assessing and managing cardiac disease in dialysis patients.

Int Urol Nephrol 2010 Dec 20;42(4):1007-14. Epub 2010 Oct 20.

Department of Medicine, Health Sciences Centre, GE-441, 820 Sherbrook St, Winnipeg, MB, R3A 1R9, Canada.

Cardiovascular disease (CVD) is the leading cause of mortality in end-stage renal disease (ESRD), approximating a 10- to 20-fold higher risk of death in dialysis patients than in the general population. Despite this, dialysis patients often undergo fewer investigations, receive less invasive procedures, and are prescribed fewer medications compared with age-matched non-ESRD patients. A lack of randomized control trials for evidence-based treatment strategies in this population may explain some of these discrepancies, but there is concern that an attitude of "therapeutic nihilism" may be impacting on the medical care of these patients. In this review, we will explore CVD in the ESRD population. Specifically, we will try to address the following issues in patients with ESRD: (1) mechanisms of CVD, (2) cardiac evaluation and the role of coronary revascularization with percutaneous or coronary artery bypass procedures, and (3) cardiac pharmacotherapy use.

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http://dx.doi.org/10.1007/s11255-010-9857-xDOI Listing
December 2010
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