Addressing Cardiovascular Concerns in the Dialysis Patient
With Peter McCullough, MD
Internist and Cardiologist at Baylor University Medical Center, Dallas, TX
He begins by outlining three important pathophysiologic constructs that result from patients being engaged in three times a week hemodialysis: chronic pressure overload, volume overload, and cardiomyopathy.1 For each, he details the evidence linking to adverse outcomes, including instability of blood pressure, coronary artery disease, cardiovascular hospitalization, and death.1-8
His summary of abnormal cardiac morphology in chronic kidney disease patients, specifically left ventricular hypertrophy, further details the cardiovascular concerns in dialysis patients.1,10,11 In his words: “To put it frankly, dialysis is rough on the heart when it’s done three times a week, in-center hemodialysis.”7
He then methodically addresses the role that intensive home hemodialysis and cardioprotective medications can play, including both the risks and the benefits. Combining clinical data with personal experience, Dr. McCullough’s presentation offers a wealth of knowledge for those concerned about the cardiac health of their dialysis patients.