A Personalized Approach to Chronic Kidney Disease and Cardiovascular Disease: JACC Review Topic of the Week |
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Authors: | Ashton C. Lai Solomon W. Bienstock Raman Sharma Karl Skorecki Frans Beerkens Rajeev Samtani Andrew Coyle Tonia Kim Usman Baber Anton Camaj David Power Valentin Fuster Martin E. Goldman |
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Affiliation: | 1. Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA;2. Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel;3. Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain |
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Abstract: | Cardiovascular disease is the most common cause of death in patients with end-stage renal disease (ESRD). The initiation of dialysis for treatment of ESRD exacerbates chronic electrolyte and hemodynamic perturbations. Rapid large shifts in effective intravascular volume and electrolyte concentrations ultimately lead to subendocardial ischemia, increased left ventricular wall mass, and diastolic dysfunction, and can precipitate serious arrhythmias through a complex pathophysiological process. These factors, unique to advanced kidney disease and its treatment, increase the overall incidence of acute coronary syndrome and sudden cardiac death. To date, risk prediction models largely fail to incorporate the observed cardiovascular mortality in the CKD population; however, multimodality imaging may provide an additional prognostication and risk stratification. This comprehensive review discusses the cardiovascular risks associated with hemodialysis, and explores the pathophysiology and the novel utilization of multimodality imaging in CKD to promote a personalized approach for these patients with implications for future research. |
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Keywords: | cardiovascular disease chronic kidney disease hemodialysis CACS" },{" #name" :" keyword" ," $" :{" id" :" kwrd0030" }," $$" :[{" #name" :" text" ," _" :" coronary artery calcium scoring CMR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0040" }," $$" :[{" #name" :" text" ," _" :" cardiac magnetic resonance CTA" },{" #name" :" keyword" ," $" :{" id" :" kwrd0050" }," $$" :[{" #name" :" text" ," _" :" coronary computed tomography angiography CVD" },{" #name" :" keyword" ," $" :{" id" :" kwrd0060" }," $$" :[{" #name" :" text" ," _" :" cardiovascular disease IDH" },{" #name" :" keyword" ," $" :{" id" :" kwrd0070" }," $$" :[{" #name" :" text" ," _" :" intradialytic hypotension RRT" },{" #name" :" keyword" ," $" :{" id" :" kwrd0080" }," $$" :[{" #name" :" text" ," _" :" renal replacement therapy SCD" },{" #name" :" keyword" ," $" :{" id" :" kwrd0090" }," $$" :[{" #name" :" text" ," _" :" sudden cardiac death SPECT" },{" #name" :" keyword" ," $" :{" id" :" kwrd0100" }," $$" :[{" #name" :" text" ," _" :" single-photon emission tomography |
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