Myocardial dysfunction in end-stage renal disease
- Christopher deFilippi, MD, FACC
Christopher deFilippi, MD, FACC
- Vice Chair of Academic Affairs
- Inova Heart and Vascular Institute
- William L Henrich, MD, MACP
William L Henrich, MD, MACP
- Professor of Medicine
- President of the Health Science Center
- University of Texas Health Science Center School of Medicine
Cardiovascular disease, particularly myocardial dysfunction, is an important cause of morbidity and mortality in patients undergoing maintenance dialysis.
This topic reviews manifestations of myocardial dysfunction, including left ventricular hypertrophy (LVH), heart failure (HF), and arrhythmia in end-stage renal disease (ESRD) patients. Coronary heart disease in ESRD is discussed elsewhere. (See "Secondary prevention of cardiovascular disease in end-stage renal disease (dialysis)" and "Clinical manifestations and diagnosis of coronary heart disease in end-stage renal disease (dialysis)" and "Treatment of coronary heart disease in end-stage renal disease (dialysis)".)
Myocardial dysfunction in the general population is discussed elsewhere. (See "Management and prognosis of asymptomatic left ventricular systolic dysfunction" and "Clinical manifestations and diagnosis of asymptomatic left ventricular systolic dysfunction" and "Prognosis of heart failure" and "Diagnosis and management of ischemic cardiomyopathy".)
Cardiovascular disease accounts for over 40 percent of deaths in ESRD patients (figure 1) . In general, patients with even mild chronic kidney disease (CKD) have a greater burden of incident cardiovascular disease compared with similar age controls .
The specific causes of cardiovascular death are the same as in the general population and include ischemic causes, such as coronary heart disease, and nonischemic causes, such as cardiomyopathy, arrhythmias, and valvular heart disease.
- United States Renal Data System. USRDS 2013 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. National Institute of Health, National Institute of Diabetes, Digestive and Kidney Diseases, Bethesda, MD 2013.
- Go AS, Chertow GM, Fan D, et al. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004; 351:1296.
- Mark PB, Johnston N, Groenning BA, et al. Redefinition of uremic cardiomyopathy by contrast-enhanced cardiac magnetic resonance imaging. Kidney Int 2006; 69:1839.
- Stewart GA, Gansevoort RT, Mark PB, et al. Electrocardiographic abnormalities and uremic cardiomyopathy. Kidney Int 2005; 67:217.
- Middleton RJ, Parfrey PS, Foley RN. Left ventricular hypertrophy in the renal patient. J Am Soc Nephrol 2001; 12:1079.
- Park M, Hsu CY, Li Y, et al. Associations between kidney function and subclinical cardiac abnormalities in CKD. J Am Soc Nephrol 2012; 23:1725.
- Parfrey PS, Foley RN, Harnett JD, et al. Outcome and risk factors for left ventricular disorders in chronic uraemia. Nephrol Dial Transplant 1996; 11:1277.
- Paoletti E, Specchia C, Di Maio G, et al. The worsening of left ventricular hypertrophy is the strongest predictor of sudden cardiac death in haemodialysis patients: a 10 year survey. Nephrol Dial Transplant 2004; 19:1829.
- Foley RN, Parfrey PS, Harnett JD, et al. The prognostic importance of left ventricular geometry in uremic cardiomyopathy. J Am Soc Nephrol 1995; 5:2024.
- Harnett JD, Kent GM, Barre PE, et al. Risk factors for the development of left ventricular hypertrophy in a prospectively followed cohort of dialysis patients. J Am Soc Nephrol 1994; 4:1486.
- Zoccali C, Benedetto FA, Tripepi G, Mallamaci F. Cardiac consequences of hypertension in hemodialysis patients. Semin Dial 2004; 17:299.
- Edwards NC, Ferro CJ, Townend JN, Steeds RP. Aortic distensibility and arterial-ventricular coupling in early chronic kidney disease: a pattern resembling heart failure with preserved ejection fraction. Heart 2008; 94:1038.
- Januzzi JL, van Kimmenade R, Lainchbury J, et al. NT-proBNP testing for diagnosis and short-term prognosis in acute destabilized heart failure: an international pooled analysis of 1256 patients: the International Collaborative of NT-proBNP Study. Eur Heart J 2006; 27:330.
- http://www2.kidney.org/professionals/KDOQI/guidelines_cvd/guide6.htm (Accessed on June 05, 2015).
- Foley RN, Parfrey PS, Kent GM, et al. Serial change in echocardiographic parameters and cardiac failure in end-stage renal disease. J Am Soc Nephrol 2000; 11:912.
- FHN Trial Group, Chertow GM, Levin NW, et al. In-center hemodialysis six times per week versus three times per week. N Engl J Med 2010; 363:2287.
- Rocco MV, Lockridge RS Jr, Beck GJ, et al. The effects of frequent nocturnal home hemodialysis: the Frequent Hemodialysis Network Nocturnal Trial. Kidney Int 2011; 80:1080.
- Culleton BF, Walsh M, Klarenbach SW, et al. Effect of frequent nocturnal hemodialysis vs conventional hemodialysis on left ventricular mass and quality of life: a randomized controlled trial. JAMA 2007; 298:1291.
- Wang AY, Li PK, Lui SF, Sanderson JE. Angiotensin converting enzyme inhibition for cardiac hypertrophy in patients with end-stage renal disease: what is the evidence? Nephrology (Carlton) 2004; 9:190.
- Yu WC, Lin YP, Lin IF, et al. Effect of ramipril on left ventricular mass in normotensive hemodialysis patients. Am J Kidney Dis 2006; 47:478.
- Lonn E, Shaikholeslami R, Yi Q, et al. Effects of ramipril on left ventricular mass and function in cardiovascular patients with controlled blood pressure and with preserved left ventricular ejection fraction: a substudy of the Heart Outcomes Prevention Evaluation (HOPE) Trial. J Am Coll Cardiol 2004; 43:2200.
- Matsumoto Y, Mori Y, Kageyama S, et al. Spironolactone reduces cardiovascular and cerebrovascular morbidity and mortality in hemodialysis patients. J Am Coll Cardiol 2014; 63:528.
- Lin C, Zhang Q, Zhang H, Lin A. Long-Term Effects of Low-Dose Spironolactone on Chronic Dialysis Patients: A Randomized Placebo-Controlled Study. J Clin Hypertens (Greenwich) 2016; 18:121.
- Shavit L, Lifschitz MD, Epstein M. Aldosterone blockade and the mineralocorticoid receptor in the management of chronic kidney disease: current concepts and emerging treatment paradigms. Kidney Int 2012; 81:955.
- Ferreira SR, Moisés VA, Tavares A, Pacheco-Silva A. Cardiovascular effects of successful renal transplantation: a 1-year sequential study of left ventricular morphology and function, and 24-hour blood pressure profile. Transplantation 2002; 74:1580.
- Rigatto C, Foley RN, Kent GM, et al. Long-term changes in left ventricular hypertrophy after renal transplantation. Transplantation 2000; 70:570.
- De Lima JJ, Vieira ML, Viviani LF, et al. Long-term impact of renal transplantation on carotid artery properties and on ventricular hypertrophy in end-stage renal failure patients. Nephrol Dial Transplant 2002; 17:645.
- Keven K, Calayoglu R, Sengul S, et al. Comparative effects of renal transplantation and maintenance dialysis on arterial stiffness and left ventricular mass index. Clin Transplant 2008; 22:360.
- USRDS 2013 Report, volume 2. Atlas ESRD, Chapter 3: Hospitalization. http://www.usrds.org/atlas13.aspx (Accessed on June 05, 2015).
- Al-Dadah A, Omran J, Nusair MB, Dellsperger KC. Cardiovascular mortality in dialysis patients. Adv Perit Dial 2012; 28:56.
- Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics--2015 update: a report from the American Heart Association. Circulation 2015; 131:e29.
- Edwards NC, Moody WE, Chue CD, et al. Defining the natural history of uremic cardiomyopathy in chronic kidney disease: the role of cardiovascular magnetic resonance. JACC Cardiovasc Imaging 2014; 7:703.
- Schietinger BJ, Brammer GM, Wang H, et al. Patterns of late gadolinium enhancement in chronic hemodialysis patients. JACC Cardiovasc Imaging 2008; 1:450.
- Patel RK, Mark PB, Macnaught G, et al. Altered relative concentrations of high-energy phosphates in patients with uraemic cardiomyopathy measured by magnetic resonance spectroscopy. Nephrol Dial Transplant 2012; 27:2446.
- Aoki J, Ikari Y, Nakajima H, et al. Clinical and pathologic characteristics of dilated cardiomyopathy in hemodialysis patients. Kidney Int 2005; 67:333.
- Dikow R, Hardt SE. The uremic myocardium and ischemic tolerance: a world of difference. Circulation 2012; 125:1215.
- Burton JO, Jefferies HJ, Selby NM, McIntyre CW. Hemodialysis-induced cardiac injury: determinants and associated outcomes. Clin J Am Soc Nephrol 2009; 4:914.
- Assa S, Hummel YM, Voors AA, et al. Hemodialysis-induced regional left ventricular systolic dysfunction: prevalence, patient and dialysis treatment-related factors, and prognostic significance. Clin J Am Soc Nephrol 2012; 7:1615.
- Harnett JD, Foley RN, Kent GM, et al. Congestive heart failure in dialysis patients: prevalence, incidence, prognosis and risk factors. Kidney Int 1995; 47:884.
- Blacher J, Guerin AP, Pannier B, et al. Impact of aortic stiffness on survival in end-stage renal disease. Circulation 1999; 99:2434.
- Moody WE, Edwards NC, Chue CD, et al. Arterial disease in chronic kidney disease. Heart 2013; 99:365.
- K/DOQI Workgroup. K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. Am J Kidney Dis 2005; 45:S1.
- Niizuma S, Iwanaga Y, Yahata T, et al. Impact of left ventricular end-diastolic wall stress on plasma B-type natriuretic peptide in heart failure with chronic kidney disease and end-stage renal disease. Clin Chem 2009; 55:1347.
- van Kimmenade RR, Januzzi JL Jr, Bakker JA, et al. Renal clearance of B-type natriuretic peptide and amino terminal pro-B-type natriuretic peptide a mechanistic study in hypertensive subjects. J Am Coll Cardiol 2009; 53:884.
- Mishra RK, Li Y, Ricardo AC, et al. Association of N-terminal pro-B-type natriuretic peptide with left ventricular structure and function in chronic kidney disease (from the Chronic Renal Insufficiency Cohort [CRIC]). Am J Cardiol 2013; 111:432.
- Cheng YJ, Yao FJ, Liu LJ, et al. B-type natriuretic peptide and prognosis of end-stage renal disease: a meta-analysis. PLoS One 2013; 8:e79302.
- Trespalacios FC, Taylor AJ, Agodoa LY, et al. Heart failure as a cause for hospitalization in chronic dialysis patients. Am J Kidney Dis 2003; 41:1267.
- Zoccali C, Benedetto FA, Tripepi G, et al. Left ventricular systolic function monitoring in asymptomatic dialysis patients: a prospective cohort study. J Am Soc Nephrol 2006; 17:1460.
- Postorino M, Marino C, Tripepi G, et al. Prognostic value of the New York Heart Association classification in end-stage renal disease. Nephrol Dial Transplant 2007; 22:1377.
- Banerjee D, Ma JZ, Collins AJ, Herzog CA. Long-term survival of incident hemodialysis patients who are hospitalized for congestive heart failure, pulmonary edema, or fluid overload. Clin J Am Soc Nephrol 2007; 2:1186.
- McCullough PA. Cardiovascular disease in chronic kidney disease from a cardiologist's perspective. Curr Opin Nephrol Hypertens 2004; 13:591.
- Genovesi S, Pogliani D, Faini A, et al. Prevalence of atrial fibrillation and associated factors in a population of long-term hemodialysis patients. Am J Kidney Dis 2005; 46:897.
- Vázquez E, Sánchez-Perales C, Borrego F, et al. Influence of atrial fibrillation on the morbido-mortality of patients on hemodialysis. Am Heart J 2000; 140:886.
- Vazquez E, Sanchez-Perales C, Garcia-Garcia F, et al. Atrial fibrillation in incident dialysis patients. Kidney Int 2009; 76:324.
- Wetmore JB, Mahnken JD, Rigler SK, et al. The prevalence of and factors associated with chronic atrial fibrillation in Medicare/Medicaid-eligible dialysis patients. Kidney Int 2012; 81:469.
- Go AS, Hylek EM, Phillips KA, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA 2001; 285:2370.
- LEFT VENTRICULAR HYPERTROPHY
- Risk factors
- Prevention and management
- HEART FAILURE
- Clinicopathologic features
- Risk factors
- - Natriuretic peptides
- Ventricular arrhythmias and sudden death
- Atrial fibrillation
- SUMMARY AND RECOMMENDATIONS