Dialysis-Induced Cardiovascular and Multiorgan Morbidity

Bernard Canaud*, Jeroen P. Kooman, Nicholas M. Selby, Maarten W. Taal, Susan Francis, Andreas Maierhofer, Pascal Kopperschmidt, Allan Collins, Peter Kotanko

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

14 Citations (Web of Science)

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.

Original languageEnglish
Pages (from-to)1856-1869
Number of pages14
JournalKidney International Reports
Volume5
Issue number11
DOIs
Publication statusPublished - Nov 2020

Keywords

  • hidden risks of dialysis
  • intradialytic morbidity
  • circulatory stress systemic stress
  • personalized medicine
  • QUALITY-OF-LIFE
  • STAGE KIDNEY-DISEASE
  • WEARABLE ARTIFICIAL-KIDNEY
  • SHORT DAILY HEMODIALYSIS
  • ABSOLUTE BLOOD-VOLUME
  • PRACTICE PATTERNS
  • INTRADIALYTIC HYPOTENSION
  • MORTALITY RISK
  • ISOLATED ULTRAFILTRATION
  • MAINTENANCE DIALYSIS

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