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Dialysis-Induced Cardiovascular and Multiorgan Morbidity
- Source :
- Kidney International Reports, Kidney International Reports, Elsevier, 2020, 5, pp.1856-1869. ⟨10.1016/j.ekir.2020.08.031⟩
- Publication Year :
- 2020
- Publisher :
- HAL CCSD, 2020.
-
Abstract
- Hemodialysis has saved many lives, albeit with significant residual mortality. Although poor outcomes may reflect advanced age and comorbid conditions, hemodialysis per se may harm patients, contributing to morbidity and perhaps mortality. Systemic circulatory “stress” resulting from hemodialysis treatment schedule may act as a disease modifier, resulting in a multiorgan injury superimposed on preexistent comorbidities. New functional intradialytic imaging (i.e., echocardiography, cardiac magnetic resonance imaging [MRI]) and kinetic of specific cardiac biomarkers (i.e., Troponin I) have clearly documented this additional source of end-organ damage. In this context, several factors resulting from patient-hemodialysis interaction and/or patient management have been identified. Intradialytic hypovolemia, hypotensive episodes, hypoxemia, solutes, and electrolyte fluxes as well as cardiac arrhythmias are among the contributing factors to systemic circulatory stress that are induced by hemodialysis. Additionally, these factors contribute to patients’ symptom burden, impair cognitive function, and finally have a negative impact on patients’ perception and quality of life. In this review, we summarize the adverse systemic effects of current intermittent hemodialysis therapy, their pathophysiologic consequences, review the evidence for interventions that are cardioprotective, and explore new approaches that may further reduce the systemic burden of hemodialysis. These include improved biocompatible materials, smart dialysis machines that automatically may control the fluxes of solutes and electrolytes, volume and hemodynamic control, health trackers, and potentially disruptive technologies facilitating a more personalized medicine approach.
- Subjects :
- medicine.medical_specialty
circulatory stress systemic stress
medicine.medical_treatment
MAINTENANCE DIALYSIS
[SDV]Life Sciences [q-bio]
030232 urology & nephrology
Hemodynamics
Context (language use)
Disease
Review
030204 cardiovascular system & hematology
Hypoxemia
03 medical and health sciences
MORTALITY RISK
0302 clinical medicine
Cardiac magnetic resonance imaging
QUALITY-OF-LIFE
INTRADIALYTIC HYPOTENSION
Hypovolemia
intradialytic morbidity
medicine
STAGE KIDNEY-DISEASE
Intensive care medicine
Dialysis
SHORT DAILY HEMODIALYSIS
medicine.diagnostic_test
business.industry
WEARABLE ARTIFICIAL-KIDNEY
personalized medicine
ISOLATED ULTRAFILTRATION
3. Good health
Nephrology
ABSOLUTE BLOOD-VOLUME
hidden risks of dialysis
Hemodialysis
medicine.symptom
PRACTICE PATTERNS
business
Subjects
Details
- Language :
- English
- ISSN :
- 24680249
- Database :
- OpenAIRE
- Journal :
- Kidney International Reports, Kidney International Reports, Elsevier, 2020, 5, pp.1856-1869. ⟨10.1016/j.ekir.2020.08.031⟩
- Accession number :
- edsair.doi.dedup.....3a00f01ad6d52ce0698f75804212b65e