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NDT Advance Access originally published online on April 12, 2006
Nephrology Dialysis Transplantation 2006 21(6):1474-1481; doi:10.1093/ndt/gfl167
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Editorial Comment

Evaluation of cardiac function in the dialysis patient—a primer for the non-expert

Eric H. Y. Ie and Robert Zietse

Department of Medicine, Erasmus MC, Rotterdam, The Netherlands

Correspondence and offprint requests to: E. H. Y. Ie. Department of Medicine, Erasmus MC, P.O. Box 2040, 300 CA Rotterdam, The Netherlands. Email: e.ie@erasmusmc.nl; yuhanyang@hotmail.com

Keywords: echocardiography; haemodialysis; hypervolaemia; left ventricular function; load dependence

The first 150 words of the full text of this article appear below.



   Introduction
 
Cardiovascular disease is a major cause of renal insufficiency, but conversely, renal insufficiency itself contributes to cardiac pathology in several ways. At least half of all the patients starting dialysis therapy have overt cardiovascular disease [1]. Chronic pressure and volume overload lead to left ventricular (LV) remodelling, with the development of a concentric or eccentric LV geometry and LV hypertrophy. The prevalence of LV hypertrophy increases with progressive renal insufficiency [2] to about 75% in dialysis patients [3,4]. Amplifying factors include hyperparathyroidism, hyperphosphataemia, angiotensin II, aldosterone, endothelin and plasma catecholamines [5–7]. In uraemia, LV hypertrophy is characterized by cardiomyocyte dropout, with diffuse interstitial fibrosis and hypertrophy of the remaining myocytes and microvascular disease [8]. These structural changes are associated with impaired LV perfusion and function. Decrease in myocardial capillary density and increase in myocyte size adversely affect myocardial . . . [Full Text of this Article]



   Changing loading conditions and left ventricular function in dialysis patients
 


   Left ventricular function assessment
 
Systolic function assessment
Diastolic function assessment


   Load dependence of left ventricular function parameters
 


   In search of ‘volume status-independent’ left ventricular function assessment in dialysis practice
 


   Left ventricular pressure–volume relations in clinical practice
 


   Conclusions
 

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