Parfrey P S, Harnett J D
Division of Nephrology, Health Sciences Centre, St. John's, Nfld., Canada.
Blood Purif. 1994;12(4-5):267-76. doi: 10.1159/000170173.
The burden of cardiac disease in dialysis patients is high. Congestive heart failure, ischemic heart disease, left ventricular hypertrophy, and systolic dysfunction occur frequently and are associated with an adverse prognosis. In addition, during dialysis therapy anemia, hypoalbuminemia, low blood pressure, and lower serum creatinine levels are adverse predictors of mortality. Risk factors for systolic dysfunction include older age, ischemic heart disease, hyperparathyroidism, and smoking. Risk factors for left ventricular hypertrophy include older age, hypertension, anemia, and diabetes mellitus. Interventions with potential for improving cardiomyopathy include normalization of hematocrit with erythropoietin, improved uremia therapy, and angiotensin-converting enzyme inhibitors. Trials to determine the most appropriate interventions to reduce the impact of cardiac disease in chronic uremia are urgently required.
透析患者的心脏病负担很重。充血性心力衰竭、缺血性心脏病、左心室肥厚和收缩功能障碍频繁发生，且与不良预后相关。此外，在透析治疗期间，贫血、低白蛋白血症、低血压和较低的血清肌酐水平是死亡率的不良预测指标。收缩功能障碍的危险因素包括高龄、缺血性心脏病、甲状旁腺功能亢进和吸烟。左心室肥厚的危险因素包括高龄、高血压、贫血和糖尿病。有可能改善心肌病的干预措施包括使用促红细胞生成素使血细胞比容正常化、改善尿毒症治疗以及使用血管紧张素转换酶抑制剂。迫切需要进行试验以确定最合适的干预措施，以减轻慢性尿毒症中心脏病的影响。
