Parfrey P S, Harnett J D
Division of Nephrology, Memorial University of Newfoundland, St. John's, Canada.
Curr Opin Nephrol Hypertens. 1994 Mar;3(2):145-54. doi: 10.1097/00041552-199403000-00004.
The burden of cardiac disease is high in chronic uremia. Cardiomyopathy results from a combination of cardiac disorders, particularly dilated cardiomyopathy, left ventricular hypertrophy with normal systolic function, and ischemic heart disease. The prognosis for these cardiac disorders is poor. Known potentially reversible risk factors include uremia, anemia, hypertension, smoking, coronary artery disease, hyperparathyroidism, hyperlipoproteinemia, and left ventricular hypertrophy. Randomized controlled clinical trials of interventions that may prevent or ameliorate cardiac disease in dialysis patients are required. These interventions include normalization of hematocrit with erythropoietin compared with partial correction of anemia, increased amount of dialysis compared with that provided by a dialysis prescription of KT/V of 1., control of blood pressure using angiotensin-converting enzyme inhibitors compared with other antihypertensive agents, control of hyperlipidemia, and treatment of diabetes with agents that prevent collagen cross-linking.
慢性尿毒症患者的心脏疾病负担较重。心肌病是由多种心脏疾病共同导致的，特别是扩张型心肌病、收缩功能正常的左心室肥厚以及缺血性心脏病。这些心脏疾病的预后较差。已知的潜在可逆危险因素包括尿毒症、贫血、高血压、吸烟、冠状动脉疾病、甲状旁腺功能亢进、高脂蛋白血症以及左心室肥厚。需要开展随机对照临床试验，以研究可能预防或改善透析患者心脏疾病的干预措施。这些干预措施包括：使用促红细胞生成素使血细胞比容正常化与部分纠正贫血相比；增加透析量与 KT/V 值为 1. 的透析处方相比；使用血管紧张素转换酶抑制剂控制血压与使用其他抗高血压药物相比；控制高脂血症；以及使用防止胶原交联的药物治疗糖尿病。
