Clinic of Urology and Nephrology, Clinical Centre of Kragujevac, Kragujevac, Serbia
Clinic of Internal Medicine, Clinical Centre of Kragujevac, Kragujevac, Serbia
Clinic of Urology and Nephrology, Clinical Centre of Kragujevac, Kragujevac, Serbia
Klinika za nefrologiju, Klinički centar Srbije, Belgrade, Serbia
Introduction. Cardiovascular diseases are the leading cause of death in haemodialysis patients. The aim of this paper is to identify risk factors and development mechanisms for cardiovascular diseases, and emphasize the significance of their timely treatment.
Methods. Expert surveys and clinical studies dealing with the etiopathogenesis, diagnosis and treatment of cardiovascular diseases in haemodialysis patients were analysed.
Results. Left ventricular hypertrophy stems from overload of the left ventricle by pressure or volume. It is found in 75% of patients and treated with optimal control of arterial blood pressure and correction of anaemia. Ischaemic heart disease is caused by coronary artery atherosclerosis and uraemic cardiomyopathy. It is found in 40% of patients and treated with antiplatelet drugs, statins, beta-blockers and percutaneous coronary interventions. Heart failure occurs either as a consequence of reduced myocardial contractility or failure of the left ventricle to receive sufficient amount of blood. It is found in 40% of patients and is treated with drugs that block the neurohormonal activation, reduce congestion and control the heart rate, as well as using therapeutic procedures for left ventricular hypertrophy regression and
prevention of myocardial ischemia. Pericardial effusion is caused by high levels of nitrogen-containing substances volume overload and uncontrolled secondary hyperparathyroidism. It is found in 20% of patients and treated with more intensive haemodialysis and pericardiocentesis. Infective endocarditis is caused by infection of the vascular access for haemodialysis. The main cause is Staphylococcus aureus,
and most commonly administered antibiotic is Vancomycin. Calcification of heart valves is the result of uncontrolled secondary hyperparathyroidism, whose treatment includes restricted phosphate intake, calcium-free phosphate binders, new vitamin D metabolites and calcimimetics.
Conclusion. Early detection of risk factors and timely implementation of treatment strategies prevent cardiovascular diseases in haemodialysis patients.
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