How does dialysis affect the heart

The following types of cardiovascular diseases that affect the blood vessels may impact people with renal disease:. Atherosclerosis : When arteries become clogged with an accumulation of cholesterol, fat and calcium also known as plaque , this can lead to a condition called atherosclerosis.

As plaque forms along the walls of the artery, the artery becomes less flexible. Also, the passageway inside the artery becomes smaller, making it difficult for blood to flow freely.

A stroke or heart attack can occur if the accumulation of plaque is thick and the artery becomes so clogged that blood cannot get through it.

High blood pressure : High blood pressure also known as hypertension occurs when blood is pushed through the arteries at an increased pressure. When blood pressure is too high, the walls of the arteries can become weakened and also cause complications such as stroke or heart attack. Complications that develop from chronic kidney disease, as well as the underlying conditions that cause chronic kidney disease, can put you at risk for cardiovascular disease.

The following are complications that develop from renal disease and can lead to cardiovascular disease:. Anemia : Anemia is when your body does not have enough red blood cells. The kidneys manufacture a hormone called erythropoietin , which tells the bone marrow to make more red blood cells.

If your kidneys are damaged, your erythropoietin levels can fall, and your body will not make enough red blood cells. Several studies have shown that anemia can be related to cardiovascular disease. Red blood cells contain a protein called hemoglobin, which helps transport oxygen throughout the body. If a body is not getting enough oxygen, the heart is not getting enough oxygen either. Without adequate oxygen to the heart muscles, a person may be susceptible to a heart attack.

Anemia can also cause the heart to pump more blood in order to circulate enough oxygen throughout the body. As the heart works harder, the muscle in the left lower chamber of the heart can develop thick walls. This is a condition called left ventricular hypertrophy LVH. LVH can increase the chance of heart failure.

High blood pressure: The kidneys make renin, which is an enzyme that helps control blood pressure. When blood pressure is too low, healthy kidneys release renin to stimulate different hormones that increase blood pressure. Damaged kidneys may release too much renin, which can lead to high blood pressure. High blood pressure increases the risk of heart attack, congestive heart failure and stroke.

High homocysteine levels : Homocysteine is an amino acid normally found in blood. Healthy kidneys regulate the amount of homocysteine in the blood and remove any excess. But damaged kidneys cannot remove the extra homocysteine. High levels of homocysteine have been linked to the build up of plaque in the blood vessels, which can lead to cardiovascular diseases such as atherosclerosis when fatty material deposited along the artery walls gets hard and blocks the blood flow and coronary artery disease.

High levels of homocysteine may also damage the lining of the blood vessels, making a person prone to blood clots which increase the risk of stroke and heart attack. Calcium-phosphate levels : Different studies have suggested a link between the calcium and phosphorus levels in patients undergoing dialysis and the hardening of the coronary arteries. Healthy kidneys help keep calcium and phosphorus levels in balance.

But damaged kidneys cannot do this. Often, there is too much phosphorus and calcium in the blood. When this happens, there is a risk for coronary artery disease. The relevance of these findings has been a renewed interest in the impact of the hemodialysis prescription in the role of SCD in hemodialysis patients.

The concept of large serum-dialysate potassium differences has spawned another approach to reduce this gradient; namely, the potential use of the new class of potassium binders. The present authors postulate that treatment with these agents could enable a change in current clinical paradigms for hemodialysis patients—treatment would obviate the necessity for low potassium concentration in the dialysate baths because it would reduce high pre-dialysate potassium levels with a consequent reduction in electrolyte potassium fluxes see Figure 1a.

Treatment with these new potassium binders may provide additional benefits in the dialysis setting see Figure 1b. In particular, treatment with these agents could facilitate treatment with previously contraindicated agents, such as renin-angiotensin-aldosterone inhibitors spironolactone, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers in hemodialysis patients, with a consequent reduction in cardiovascular events.

Another approach, of course, to potentially achieve the same goals could be the increased use of nocturnal hemodialysis. Despite these advances, the present authors strongly believe that the medical community is still in its infancy with regard to modulating the hemodialysis prescription in an attempt to reduce SCD in hemodialysis patients.

In particular, we believe that it is critical to first identify the specific arrhythmic event that is responsible for SCD in these patients. While the traditional view has been that ventricular arrhythmias are the primary abnormality responsible for SCD, this paradigm may not hold true in the setting of SCD in hemodialysis patients. Indeed, early results from the MiD study 30 suggest that bradycardias could also play an important role, as could the presence of undetected atrial fibrillation.

Once these arrhythmias are identified, these events then need to be targeted, both through a tailoring of the dialysis prescription and through the use of drugs, devices, and—potentially—biologics; keeping in mind, of course, that therapies that target the cause of the arrhythmias and SCD myocardial fibrosis and fluid and electrolyte fluxes, for example are likely to be more effective than therapies that target only the arrhythmias remember the Cardiac Arrhythmia Suppression Trial; CAST.

Last, but not least, the present authors strongly believe that despite the challenges in addressing SCD in hemodialysis patients, there is an opportunity here to use the dialysis unit as the central hub to develop and test novel drugs, devices, and process-of-care interventions including the modulation of the dialysis prescription that target SCD.

Most patients with ESRD depend on intermittent hemodialysis to maintain levels of serum potassium and other electrolytes within a normal range. In daily practice, in the management of patients with ESRD, dialysis adequacy is optimized and patients are advised to avoid potassium-rich food. Sometimes potassium-binding resins are used to increase gastrointestinal excretion of potassium. Furthermore, most patients receive hemodialysis with relatively low potassium dialysate usually 2.

Disclosures: Dr. Epstein is a consultant for Relyspa, Inc. Roy-Chaudhury is a consultant for Medtronic. Prevalence of chronic kidney disease in the United States. Bethesda, MD, Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization.

N Engl J Med. Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction. Herzog CA. Sudden cardiac death and acute myocardial infarc- tion in dialysis patients: perspectives of a cardiologist. Semin Nephrol. Sudden death due to cardiac arrhythmias.

Kidney Int. Overview: increased cardiovascular risk in patients with minor renal dysfunction: an emerging issue with far-reaching consequences. J Am Soc Nephrol. Ritz E, Wanner C. The challenge of sudden death in dialysis patients. Clin J Am Soc Nephrol. If you are having symptoms, there are many tests that your doctor might suggest. The type of test they recommend depends on what type of heart disease your doctor thinks you may have. These tests may include blood work, chest x-rays, or other tests such as:.

If you have heart disease or high blood pressure and CKD, your doctor may prescribe medicines to control your heart disease or high blood pressure. Some of these medicines may cause problems with your kidneys. Talk to your doctor about which medicine could work best for you. Your doctor may also recommend an exercise program or suggest you visit a dietitian to create a kidney- and heart-friendly diet. The best way to prevent heart disease is to manage the problems that can lead to it.

These include conditions such as anemia, high blood pressure, and problems with calcium and phosphorous levels. Some other ways to keep your kidney and heart health on track are to:. Talk with your doctor about other ways to reduce your chance of getting heart disease if you have CKD. What you eat and how often you exercise are important ways you can help to prevent heart disease. If you have CKD, your doctor may recommend regular physical activity and also refer you to a dietitian who can work with you to create a kidney and heart-friendly diet.

What type of exercise you do and how frequently you do it are things you should discuss with your doctor. Types of physical activity may include:. Your doctor and dietitian will consider what stage of kidney disease you have, how that affects your individual risk for developing heart disease, and create a meal plan that will benefit your health. Generally, a heart-healthy diet is low in fat and salt.