Nephrology Clinic and Dialysis Center, Parhon University Hospital, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania.
J Nephrol. 2009 Nov-Dec;22(6):716-25.
Despite substantial progress in dialysis patients' management, cardiovascular disease remains the major cause of death. Nearly half of deaths on dialysis are secondary to myocardial infarction, cardiac arrest, malignant arrhythmias and other cardiac causes. The high prevalence of diabetes, anemia, hyperparathyroidism and hypertension among chronic dialysis patients fosters structural heart diseases. Moreover, fluid overload and metabolic abnormalities such as metabolic acidosis, dyskalemia and dysmagnesemia lead to an increased risk of clinically significant arrhythmias and sudden cardiac death. End-stage renal disease (ESRD) is often characterized by the presence of sympathetic hyperactivity and activation of the renin-angiotensin-aldosterone system (RAAS). Control of sympathetic outflow, blockade of the RAAS and prevention of electrolyte disorders should be the mainstay of cardiovascular prevention in ESRD patients. This review summarizes the current available literature regarding the epidemiology of arrhythmias in dialysis patients, the underlying mechanism of atrial fibrillation or sudden death and potential interventions to reduce the risk of arrhythmias in dialysis patients, including medical therapy or defibrillators.
尽管透析患者的管理取得了重大进展，但心血管疾病仍然是主要的死亡原因。近一半的透析患者死亡是由于心肌梗死、心脏骤停、恶性心律失常和其他心脏原因。慢性透析患者中糖尿病、贫血、甲状旁腺功能亢进和高血压的高发率促使结构性心脏病的发生。此外，液体超负荷和代谢异常，如代谢性酸中毒、电解质紊乱和低镁血症，导致临床显著心律失常和心脏性猝死的风险增加。终末期肾病（ESRD）常伴有交感神经兴奋和肾素-血管紧张素-醛固酮系统（RAAS）的激活。控制交感神经输出、阻断 RAAS 和预防电解质紊乱应成为 ESRD 患者心血管预防的主要手段。这篇综述总结了目前关于透析患者心律失常的流行病学、心房颤动或心脏性猝死的潜在机制以及降低透析患者心律失常风险的潜在干预措施的相关文献，包括药物治疗或除颤器。
