Echocardiography: Providing Additional Insights into Cardiovascular Structural and Functional Abnormalities in Advanced CKD

[摘要] It is now a well recognized fact that cardiovascular disease is an important determinant of poor outcomes in patients with ESRD. Perhaps less well recognized is that cardiovascular outcomes in patients with advanced CKD are similar to and, on the basis of certain observational studies, worse than outcomes in patients with ESRD (1). Several hypotheses could account for this observation; one possible explanation relates to underlying structural and functional cardiovascular abnormalities such as left ventricular (LV) hypertrophy and LV dysfunction. At the outset, it is important to emphasize that advanced CKD and ESRD are on a clinical continuum. The transition from advanced CKD to ESRD requiring renal replacement therapy is based on the judgment of the clinician, which factors in several clinical and nonclinical variables, including symptoms and laboratory data indicative of uremia, clinical context, and patient preference. Hence, although this transition can be considered discrete or binary in clinical studies, it is dynamic in clinical practice. However, this transition to dialysis is extremely important from a physiologic standpoint, because the period after dialysis initiation is associated with increased risk of adverse clinical, particularly cardiovascular, outcomes (2), putatively related to increased electrolyte fluxes, hemodynamic stressors, and infectious complications. The rate of sudden cardiac death is markedly increased in incident hemodialysis patients, peaking at 2 months after dialysis initiation (3).

[学科分类] 泌尿医学

[关键词] Bone marrow necrosis;Sickle cell disease;Hyperhemolysis syndrome