Management of Arrhythmia and SCD in Hemodialysis Patients

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概要

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• Patients on maintenance HD are at increased risk for dysrhythmias, cardiac arrest, and SCD. HD patients with underlying structural or functional cardiovascular disease are at muchu higher risk fir these dysrhythmias and cardiac arrest because of increased dysrthythmogenicity due to dynamic changes in electrolytes, volume status, blood pressure and the use of multiple medications. IHD is present in many patients even at the time of HD. HD patients with either symptomatic or asymptomatic CAD are at increased risk for dysrhythmias and SCD. AF is perhaps the most commmonly diagnosed dysrhythmia in the HD patients. AF was reported in 27.0% of HD patients, and associated with IHD, dilated cardiomyopathy, acute pulmonary edema, valvular disease, and older age. The use of carvedilol or telmisartan reduced morbidity and mortality in dialysis patients with dilated cardiomyopathy. A small study demonstrated that HD patients may not tolerate sotalol due to an increased risk of torsade pointes. In HD patients, ICD therapy is apparently underused. ICD implantation in cardiac arrest survivors on dialysis is associated with greater survival. Warfarin use among patients with both HD patients and AF associates with an increased risk for stroke. The risk is greatest in warfarin users who do not receive in-facility PT-INR monitoring. Moreover, the use of high dose of warfarin accelerate the potetial risk of metastatic calcification in HD patients with elevated serum Ca and phosphate.

著者

• Hase Hiroki

  Division Of Cardiovascular Medicine Toho University Ohashi Medical Center

• Hase Hiroki

  Division of Nephrology, Toho University Ohashi Medical Center

関連論文

• PE-032 Influence of End Stage Renal Disease on Cardiac Risk in Diabetic Patients Assessed by Stress Myocardial Perfusion SPECT Images(PE006,Kidney/Renal Circulation/CKD 1 (H),Poster Session (English),The 73rd Annual Scientific Meeting of The Japanese Circ
• OJ-203 The Difference of the Predictors of the Cardiac Event in the Diabetic Patients with and without Previous Coronary Artery Disease(Diabetes/Obesity/Metabolic syndrome-04, The 71st Annual Scientific Meeting of the Japanese Circulation Society)
• The impact of chronic kidney disease as a predictor of major cardiac events in patients with no evidence of coronary artery disease
• A suspected case of paradoxical renal embolism through the patent foramen ovale
• Impact of chronic kidney disease and stress myocardial perfusion imaging as a predictor of cardiovascular events
• Management of Arrhythmia and SCD in Hemodialysis Patients

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