Ahmadmehrabi Shadi, Tang W H Wilson
Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, OH, USA.
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.
Semin Dial. 2018 May;31(3):258-267. doi: 10.1111/sdi.12694. Epub 2018 Apr 6.
More than half of all deaths among end stage renal disease (ESRD) patients are due to cardiovascular disease (CVD). Cardiovascular changes secondary to renal dysfunction, including fluid overload, uremic cardiomyopathy, secondary hyperparathyroidism, anemia, altered lipid metabolism, and accumulation of gut microbiota-derived uremic toxins like trimethylamine N-oxidase, contribute to the high risk for CVD in the ESRD population. In addition, conventional hemodialysis (HD) itself poses myocardial stress and injury on the already compromised cardiovascular system in uremic patients. This review will provide an overview of cardiovascular changes in chronic kidney disease and ESRD, a description of reported mechanisms for HD-induced myocardial injury, comparison of HD with other treatment modalities in the context of CVD, and possible management strategies.
终末期肾病（ESRD）患者中超过一半的死亡是由心血管疾病（CVD）所致。继发于肾功能不全的心血管变化，包括液体超负荷、尿毒症心肌病、继发性甲状旁腺功能亢进、贫血、脂质代谢改变以及肠道微生物群衍生的尿毒症毒素（如三甲胺N-氧化物）的蓄积，导致ESRD人群发生CVD的风险很高。此外，传统血液透析（HD）本身会给已经受损的尿毒症患者心血管系统带来心肌应激和损伤。本综述将概述慢性肾脏病和ESRD中的心血管变化，描述已报道的HD诱导心肌损伤的机制，比较HD与其他治疗方式在CVD背景下的情况，以及可能的管理策略。
