Cardiovascular status in the elderly on hemodialysis (HD) and peritoneal dialysis (PD)
✍ Scribed by Mario Gaggiotti; Rosario Maiorca
- Publisher
- Springer
- Year
- 1996
- Tongue
- English
- Weight
- 680 KB
- Volume
- 6
- Category
- Article
- ISSN
- 0924-8455
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✦ Synopsis
The cardiovascular risk of death is greater for dialysis patients than for the general population and differs from country to country. At present, cardiovascular disease is the most frequent cause of death for patients on dialysis, accounting for 48% of deaths in the USA and 48-53% in Europe. It is not surprising that dialyzed elderly have a death rate that is more than double that of younger patients. However, the percentage of cardiac deaths of the total is the same for older and younger patients.
In this paper we shall touch upon a few important aspects of cardiac function in uremics, referring to the literature and the experience of our center. We shall briefly examine left ventricular hypertrophy (LVH), systolic dysfunction (SD), diastolic dysfunction (DD), heart calcification (HC) and ischemic heart disease (IHD).
ESRD patients very frequently have LVH, which is associated with increased mortality and cardiac morbidity. In the elderly, LVH is greater but on dialysis tends to decrease more than in the younger, especially on CAPD. Systolic dysfunction is not frequent but when present it affects survival. Diastolic dysfunction is very frequent, it is worsened by both aging and uremia and does not improve on dialysis. Myocardial and valvular calcifications are very frequent and severe in uremics, particularly in the elderly, and are also important factors of coronary atherosclerosis, of cardiovascular morbidity and of mortality. Ischemic heart disease, may be linked to coronary atherosclerosis, but often it is not associated with significant stenosis of coronary arteries.
Altogether, for the elderly on dialysis there is no evidence yet that the cardiovascular function is preserved better by CAPD or HD. More studies of comparable patients, taking into account the effects of adequate dialysis doses, are needed before we can draw a firm conclusion.