The heart in uremia: Role of hypertension, hypotension, and sleep apnea

Cardiovascular disease is the leading cause of morbidity and mortality in e nd-stage renal disease. Causes include those usually found in the general p opulation, those related to the uremic status, and those related to dialyti c treatment. Hypertension, hypotension, anemia, hypoalbuminemia, malnutriti on, dyslipidemia, reactive C protein, calcium-phosphate product, dialysis m odalities, and hyperhomocysteinemia are discussed extensively. Special emph asis is put on hyperparathyroidism as a traditional toxin. The emergent rol e of sleep apnea has been confirmed in animal models as well as in humans s tudied using polysomnography. There are difficulties in diagnosing coronary disease, because angiography is not risk-free, is expensive, and should be reserved for patients having symptoms of heart failure and/or patients hav ing diabetes mellitus, and/or patients entering a transplantation list. Thi s allows patients with coronary disease to undergo coronary artery bypass ( preferably) or percutaneous transluminal angioplasty. Patients for whom sur gery is not appropriate should be treated using more traditional medical pr ocedures. (C) 2001 by the National Kidney Foundation, Inc.