Risk factors and potential preventive measures for vascular disease progression in hemodialysis patients

David Tovbin, Anne Ghena, Anatte Kormendi, Alla Shnaider, Anna Basok, Moshe Zlotnik

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations

Abstract

The leading cause of the high morbidity and mortality in hemodialysis (HD) patients is cardiovascular disease (CVD), followed by infections. A combination of patho-physiological processes is involved in the development and progression of vascular disease in HD patients including volume-overload/hypertension, atherosclerosis, calcification and thrombosis. A vicious circle of inflammation and oxidative stress, augmented by iatrogenic effects of HD lines, dialyzers and water contribute to the severity of atherosclerosis and possibly of vascular calcification. Specific metabolic risk factors include increased homocysteine levels, abnormal lipid profile and insulin resistance. The iatrogenic effect of associated therapy such as intravenous (IV) iron administration, active vitamin D derivatives, calcium containing phosphate binders, high dialysate Na concentration and possibly heparin, may add to the detrimental effects of uremia and co-morbid diseases. Potential mechanisms for iatrogenic processes may include effects of IV iron on protein oxidation and leucocyte adhesion to endothelial cells, as well as adverse effects of anticoagulation such as sub-clinical heparin induced thrombocytopenia (HIT). Preventive measures require a multidirectional approach to improve dialysis delivery and volume/blood pressure control, and to minimize adverse effects of current common essential therapies.

Original languageEnglish
Pages (from-to)205-212
Number of pages8
JournalVascular Disease Prevention
Volume4
Issue number3
DOIs
StatePublished - 1 Aug 2007
Externally publishedYes

Keywords

  • Adhesion
  • Advanced oxidative protein products (AOPP)
  • Anemia
  • Atherosclerosis
  • Blood volume
  • Calcification
  • Diabetes mellitus
  • Endothelial dysfunction
  • Heparin
  • Heparin induced thrombocytopenia
  • Hypertension
  • Inflammation
  • Iron
  • Oxidative stress
  • Thrombosis

ASJC Scopus subject areas

  • Epidemiology
  • Cardiology and Cardiovascular Medicine

Fingerprint

Dive into the research topics of 'Risk factors and potential preventive measures for vascular disease progression in hemodialysis patients'. Together they form a unique fingerprint.

Cite this