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In their broad spectrum, cardiovascular diseases are, collectively, the major cause of death in patients on dialysis. The population of patients treated with peritoneal dialysis and hemodialysis are not only subject to the traditional risk factors for heart disease, but also to certain uremia-associated risk factors that are unique in this population. In the dialysis population, data regarding the effectiveness of routine pharmacologic and procedural interventions on cardiovascular outcomes are limited. Most dialysis patients are excluded from clinical trials, and so data from randomized controlled trials investigating outcomes in patients undergoing peritoneal dialysis or hemodialysis are almost absent. In this review, we discuss some of the major cardiovascular problems in the dialysis population, the impact of those problems on survival, and when data are available, the impact of therapeutic strategies.

Our understanding of the cardiorenal syndrome continues to progress. Decades of research have led to a better definition of the clinical cardiorenal syndrome and have laid the groundwork for understanding its pathophysiology. Although improvements have been made, there are still knowledge gaps concerning the interactions of these two organ systems. In the present review, we examine those interactions in the setting of acute and chronic cardiac decompensation and the resulting impacts on renal dysfunction. Recognition and prevention of this syndrome may help to better serve a growing patient population.

Cardiovascular diseases, in their broad spectrum, are collectively the major cause of death in patients on dialysis. The population of patients treated with peritoneal and hemodialysis are not only subject to the traditional risk factors for heart disease, but also to certain uremia-associated risk factors that are unique in this population. Limited data are available on the effectiveness of routine interventions on cardiovascular outcomes in dialysis patients. Because most dialysis patients are excluded from clinical trials, data from randomized controlled trials regarding outcomes in patients undergoing peritoneal dialysis are almost absent. The present review discusses some of the major cardiovascular problems in the dialysis population, the impact of those problems on survival, and the available therapeutic strategies.

Coronary artery disease is the number one cause of death in patients with chronic kidney disease (CKD). However,patients with impaired renal function are much less likely than patients with normal renal function to undergo left heart catheterization and coronary intervention. Patients that do receive invasive strategies experience more bleeding and higher rates of ischemic events. In this review, we examine advances in percutaneous coronary intervention--including antiplatelet therapy and drug-eluting stents--and their impact on patients with CKD.

In recent decades, echocardiography has evolved into a useful tool in the assessment of cardiovascular anatomy, physiology, and pathology. Its use has enabled the measurement of structural parameters such as left ventricular mass, which has both diagnostic and prognostic value. Doppler measurements have allowed for accurate hemodynamic assessment that can help to guide therapy. Newer methods have also been used and proposed to evaluate systolic and diastolic function. Here, we review the use of echocardiography in cardiac structural and functional assessment, providing insights into the challenges and limitations of these techniques in dialysis patients.

Heart failure is a major public health problem and a leading cause of hospitalization in adults in the United States. Renal dysfunction is emerging as a critical feature of patients hospitalized with heart failure and as a strong predictor of increased mortality. Despite the challenges and unique problems of patients with heart failure who have end-stage renal disease, evidence-based data regarding optimal management of these patients are limited. Here, we explore recent advances in the understanding of cardiorenal interactions and future directions in management strategies for patients with congestive heart failure on dialysis.

Cardiovascular disease is the leading cause of death among people with chronic kidney disease. In this review, we provide an update on how the association between renal dysfunction and cardiovascular disease goes beyond traditional cardiac risk factors, and we consider some of the key studies that link renal dysfunction with the development of cardiovascular morbidity and mortality. Unique challenges facing clinicians that treat patients with end-stage renal disease, particularly patients on peritoneal dialysis, are discussed. The potential relationship between endothelial progenitor cells and the renal-cardiovascular relationship are explored. We propose that moderate-to-severe renal dysfunction should be considered a coronary artery disease equivalent and that further investigation needs to be conducted to understand this key relationship.