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Year : 2020  |  Volume : 30  |  Issue : 7  |  Page : 67

Cardio vascular disease monitoring and therapy

Date of Web Publication15-Jul-2020

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0971-4065.289818

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How to cite this article:
. Cardio vascular disease monitoring and therapy. Indian J Nephrol 2020;30, Suppl S1:67

How to cite this URL:
. Cardio vascular disease monitoring and therapy. Indian J Nephrol [serial online] 2020 [cited 2020 Nov 27];30, Suppl S1:67. Available from:

  Rationale for Separate Guideline for Monitoring Cardiovascular Disease in Hemodialysis Patients Top

The burden of cardiovascular disease (CVD) in CKD is very high in HD patient population. On the top of the traditional risk factors – such as diabetes, HTN, dyslipidemia, and smoking, nontraditional risk factors such as volume overload, anemia, mineral and bone disorders, inflammation, and oxidative stress also contribute significantly to very high prevalence of CVD in patients on HD [Table 1]. The survival of patients on MHD is poor, only 40% survive 5 years in the USA and majority of them (about 40%) die because of cardiac problems. The exact survival data are lacking in India, and it is not expected to be better than that. The common types of CVD in HD population are atherosclerotic vascular disease, especially involving coronary and intracerebral arteries, and peripheral vascular disease. Approximately 80% patients on HD have one or more kinds of cardiac diseases namely left ventricular hypertrophy, coronary artery disease, congestive heart failure, atrial fibrillation, and valvular heart disease. Sudden cardiac death is also common in these patients on dialysis.
Table 1: Category of risk factor

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However, the treatment options are similar at present and the impact of these potential treatable factors is profound. Lifestyle factors such as smoking and tobacco chewing, decreased physical activity, increased depression, and anxiety also significantly contribute to this burden.

Evidence based on large randomized controlled trials and meta-analyses on the outcome of therapy for CVD in HD patients is lacking. Extrapolation of data from studies of cardiac diseases in general population which usually exclude patients with CKD, particularly dialysis patients, may be ambiguous. Patients on dialysis differ from the general population with respect to cardiovascular disease profile, response to therapy and side effects of medications. Considering these limitations, we put forth the following guidelines for cardiovascular monitoring for patients on dialysis:

  1. We recommend 12-lead ECG, chest X-ray, and echocardiogram in all patients to assess their baseline status and to identify and stratify risk for future CVD
  2. We recommend that investigations for CVD should be deferred till the weight, hemoglobin, volume, electrolyte, and divalent ions targets are achieved unless there are pressing or urgent indications
  3. We recommend that additional tests such as dobutamine stress echocardiography, radionuclide scintigraphy, or coronary angiogram if indicated should be decided in consultation with a cardiologist
  4. We suggest that any other test such as cardiac CT scan or magnetic resonance imaging should be done only if absolutely indicated
  5. We suggest that any acute cardiac event should be evaluated with 12-lead ECG and biochemical markers of ischemia. Every patient with acute event should be evaluated by a cardiologist.
  6. We suggest using serum creatine kinase-muscle/brain, troponin T/I, or LDH to assess acute ischemia. Troponin I is preferred over T as the levels of troponin T may be raised up to three times in HD population in the absence of ischemia. These enzymes should be ordered when acute coronary ischemia is suspected; they have no role in routine screening for coronary artery disease
  7. We suggest that a 12-lead ECG, chest X-ray, and echocardiogram be performed in all HD patients every 6 months. The decision to perform additional tests such as coronary angiogram should be individualized in consultation with a cardiologist
  8. We suggest adopting care for all lifestyle factors and optimizing all possible modifiable traditional and nontraditional risk factors for CVD.W


  [Table 1]


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Indian Journal of Nephrology
Published by Wolters Kluwer - Medknow
Online since 20th Sept '07