According to the research, the cardiovascular disease is the leading cause of death in chronic kidney patients, no matter in any age, renal dialysis in cardiovascular disease mortality is higher than general population, there are many risk factors directly or indirectly affect the cardiovascular system, in addition to the common factors such as hypertension, diabetes, hyperlipidemia, smoking, in addition, there are some non-traditional risk factors associated with uremia: too much body fluids, anemia, low serum albumin leels, chronic inflammation, oxidative stress, calcium phosphate abnormality, etc were also associated with cardiovascular disease.
The artery wall thickens
From a pathological point of view, there is a thickening of the membrane of the coronary artery in patients with end-stage renal disease. By ultrasound measurement of carotid artery intima, the film thickness (carotid intima - media thickness, CIMT), cardiovascular disease in high-risk groups such as the elderly or patients with type 2 diabetes found increased CIMT situation; Past studies have also found blood dialysis patients of carotid artery and femoral artery intima, thickening of the film more than the average person, a more recent study pointed out that in less severe in patients with chronic kidney disease can already be found CIMT increases, while CIMT is considered to be significant predictors of cardiovascular disease mortality of patients with chronic kidney disease (CKD).
Hardening of the arteries in itself is the result of tube wall thickening and vascular calcification, hardening of the arteries may be early features of chronic kidney disease (CKD) artery disease, and adult dialysis patients and patients with diabetes if the higher the degree of carotid artery and aortic stiffness, the higher the risk of death.
Patients with chronic kidney disease may have calcification of the lining of the arteries or the middle membranes, both of which are strongly associated with abnormal calcium and phosphorus balance. Study, patients with end-stage renal disease than in patients with coronary heart disease have more severe calcification, and calcification in chronic kidney disease may occur much earlier, even in children or adolescents can be found.
Left ventricular hypertrophy
Left ventricular hypertrophy in dialysis patients is common, largely because of ventricular wall under overload pressure caused by too much or body fluids, finally often leads to HCM, reduce ventricular systolic function. Left ventricular hypertrophy is a risk factor for poor prognostic and high mortality in dialysis patients.
Left ventricular function changes
Cardiac ultrasound study found that about 20% of dialysis patients with ventricular systolic dysfunction, early in the disease may not have any clinical different shape, but slowly will develop symptoms of congestive heart failure, severe ventricular systolic dysfunction may result in reduced systolic blood pressure, which may explain part in dialysis patients with systolic blood pressure drop and even death.
And part of its symptoms are from the ventricular diastolic function in patients with abnormal, for dialysis patients, abnormal ventricular diastolic function more common than abnormal contraction (about 50%), because of the poor diastolic function in patients with even in the face of mild fluid volume increases, also can make the left ventricle pressure big rise, cause pulmonary edema and dyspnea. Conversely, a slight reduction in fluid volume may also cause the left ventricular stress to plummet, resulting in lower blood pressure. In terms of prognosis, ventricular diastolic dysfunction is even worse than contracting.
Heart valve disease
Dialysis patients with mitral valve and aortic valve calcification were about four times as high as the average person and were associated with abnormal calcium phosphorus balance. Mitral valve calcification could lead to some complications: conduction system abnormal phenomenon, thrombosis, infective endocarditis, mitral valve insufficiency caused by left heart volume overload; Aortic calcification accelerates the hardening of the aorta, leading to aortic stenosis, which in turn causes the left heart to load too much.
Infective endocarditis is a common complication of hemodialysis, often of bacteremia caused by hemodialysis catheter infection occurs, most of the infections are caused by gram-positive bacteria (such as staphylococcus aureus and epidermis staphylococcus, etc.), is the most commonly affected mitral valve, the second is the aortic valve, if the presence of valvular calcification or other valvular disease, the risk will increase.
Coronary heart disease
In patients with end-stage kidney disease, coronary heart disease and acute myocardial infarction is common, sclerosis of arterial congee shape (atherosclerosis) and hardening of the arteries (arteriosclerosis) are its pathogenesis, and other diseases could be uremia itself (such as hypertension, diabetes) caused by vascular lesions caused by metabolic abnormalities.
Many heart disease may be complicated by arrhythmia, left ventricular hypertrophy, valvular disease, coronary heart disease and other blood dialysis in rapid changes when the electrolyte concentration in the body, may also affect the conduction of the heart, lead to arrhythmias. The use of dialysis liquid potassium concentration < 2.0 mM may increase the risk of cardiac arrhythmia and cardiac arrest, so the dialysate should be carefully used.
Chronic kidney disease patients suffering from heart disease, stroke, peripheral artery disease is higher, in the early chronic kidney disease, the risk of cardiovascular disease has been improved, high blood pressure early chronic kidney disease (CKD) seems to be the most important risk factor, with the progress of the kidney disease and other metabolic abnormalities is important, such as calcium phosphorus balance, that secondary sexual vice hyperthyroidism can increase the risk of cardiovascular disease, therefore, to understand all kinds of cardiovascular disease risk factors and control is very important, and reduce cardiovascular complications is the target we need to work together.