CARDIOVASCULAR SURVIVAL IN PATIENTS WITH END-STAGE RENAL-DISEASE - PARAMETER OF ADEQUACY OF DIALYSIS TREATMENT

Data of excessively high and further increasing mortality in patients with end-stage renal disease recently aroused the medical community: A nnual mortality of hemodialysis patients in the USA was as high as 23. 4% in 1987, as compared to 9.7% in Europe and 8.8% in Japan. Cardiovas cular factors and duration of weekly dialysis treatment are of central relevance for increased mortality in several recently released invest igations: Independent of the method of blood purification, risk factor s for increased mortality are arterial hypertension and left ventricul ar hypertrophy, dilatation and systolic as well diastolic dysfunction. The tendency towards decreasing weekly dialysis durations in the USA due to enormous cost pressure has untoward effects on survival; whethe r this is caused from insufficient quality of blood purification or fr om increased hemodynamic stress cannot be discriminated to date. Howev er, excellent long-term patient survival has been reported from patien ts on constant long-term hemodialysis treatment (3 x 8 h/week) for ove r 20 years in Tassin, France. These patients have extremely few cardio vascular complications as a consequence of favorable hemodynamic condi tions during and between dialysis sessions, and of excellent control o f hypertension. Normalization of blood pressure is achieved by reducti on of dry weight, but not by medical antihypertensive therapy. The maj or result of mortality analyses of dialysis patients is that most risk factors of increased mortality are accessible to therapeutic interven tion. To improve survival, a central goal must be to achieve effective blood pressure control. The choice of method should be influenced by concomitant systolic or diastolic left ventricular dysfunction. Also, weekly dialysis duration should be increased as far as limited financi al and organisational resources as well as patient compliance permit.