National Institute of Diabetes and Digestive and Kidney Disease, Division of Kidney, Urology, and Hematology, 6707 Democracy Blvd, Bethesda, MD 20892-5458, USA.
Division of Nephrology, Indiana University School of Medicine, 950 W. Walnut Street R2-202, Indianapolis, IN 46202, USA.
Eur Heart J. 2021 Mar 31;42(13):1244-1253. doi: 10.1093/eurheartj/ehaa1049.
Chronic kidney disease (CKD) patients require dialysis to manage the progressive complications of uraemia. Yet, many physicians and patients do not recognize that dialysis initiation, although often necessary, subjects patients to substantial risk for cardiovascular (CV) death. While most recognize CV mortality risk approximately doubles with CKD the new data presented here show that this risk spikes to >20 times higher than the US population average at the initiation of chronic renal replacement therapy, and this elevated CV risk continues through the first 4 months of dialysis. Moreover, this peak reflects how dialysis itself changes the pathophysiology of CV disease and transforms its presentation, progression, and prognosis. This article reviews how dialysis initiation modifies the interpretation of circulating biomarkers, alters the accuracy of CV imaging, and worsens prognosis. We advocate a multidisciplinary approach and outline the issues practitioners should consider to optimize CV care for this unique and vulnerable population during a perilous passage.
慢性肾脏病（CKD）患者需要透析来治疗尿毒症的进行性并发症。然而，许多医生和患者没有认识到，尽管透析的开始通常是必要的，但它会给患者带来大量心血管（CV）死亡的风险。虽然大多数人认为随着 CKD 的进展，CV 死亡率大约翻了一番，但这里提出的新数据显示，在开始慢性肾脏替代治疗时，CV 风险飙升至比美国人口平均水平高 20 多倍，并且这种升高的 CV 风险会持续到透析的前 4 个月。此外，这一峰值反映了透析本身如何改变 CV 疾病的病理生理学，并改变其表现、进展和预后。本文综述了透析开始如何改变循环生物标志物的解释，改变 CV 成像的准确性，并恶化预后。我们提倡采用多学科方法，并概述了从业者在这一危险时期应考虑的问题，以优化对这一独特和脆弱人群的 CV 护理。
