| Haemodialysis-induced myocardial stunning in chronic kidney disease - a new aspect of cardiovascular disease. | |
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MedLine Citation:
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PMID: 20093813 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Chronic haemodialysis (HD) patients are already primed by a large number of structural and functional peripheral vascular and cardiac abnormalities to experience demand myocardial ischaemia. Transient myocardial ischaemia may lead to left ventricular (LV) dysfunction that can persist after the return of normal perfusion. This prolonged dysfunction is known as myocardial stunning. Repetitive episodes of ischaemia can be cumulative and have been shown to lead to prolonged LV dysfunction (in patients with ischaemic heart disease). Conventional HD itself is a sufficient cardiovascular functional stressor to precipitate such recurrent ischaemic insults, leading to myocardial functional and structural changes, eventually resulting in fixed systolic dysfunction and heart failure (conferring a dismal prognosis for patients undergoing dialysis). Furthermore these same haemodynamic insults may also adversely affect other vascular beds in other vulnerable organ systems, driving an even wider range of pathophysiological processes. A variety of therapeutic manoeuvres aimed at improving the haemodynamic tolerability of treatment have been shown to reduce acute dialysis-induced myocardial ischaemia. This article aims to give an appreciation of the possibility that modification of the dialysis treatment to improve tolerability of therapy may have the potential to provide us with additional therapeutic targets, to reduce currently excessive rates of cardiovascular morbidity and mortality. |
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Authors:
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Chris W McIntyre |
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Publication Detail:
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Type: Journal Article; Review Date: 2010-01-08 |
Journal Detail:
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Title: Blood purification Volume: 29 ISSN: 1421-9735 ISO Abbreviation: Blood Purif. Publication Date: 2010 |
Date Detail:
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Created Date: 2010-01-22 Completed Date: 2010-04-29 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8402040 Medline TA: Blood Purif Country: Switzerland |
Other Details:
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Languages: eng Pagination: 105-10 Citation Subset: IM |
Copyright Information:
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Copyright (c) 2010 S. Karger AG, Basel. |
Affiliation:
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Department of Renal Medicine, Derby City Hospital, Derby, and School of Graduate Entry Medicine and Health, University of Nottingham, Nottingham, UK. chris.mcintyre@nottingham.ac.uk |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Arrhythmias, Cardiac
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etiology,
prevention & control Baroreflex / physiology Body Temperature Coronary Disease / complications Death, Sudden, Cardiac / etiology, prevention & control Disease Susceptibility Follow-Up Studies Heart Failure / etiology, prevention & control Hemodynamics Humans Hypertension / complications, physiopathology Hypotension / etiology*, physiopathology Kidney Failure, Chronic / therapy* Myocardial Stunning / etiology* Positron-Emission Tomography Randomized Controlled Trials as Topic / statistics & numerical data Reflex, Abnormal Renal Dialysis / adverse effects*, methods Ventricular Dysfunction, Left / etiology, prevention & control, radionuclide imaging, ultrasonography |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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