Cardiac Dysfunction in Chronic Uremia

Cardiac disease is the major cause of death in dialysis patients, accounting for over one third of deaths. This book focuses on myocardial function and dysfunction in chronic uremia. It is aimed at practicing and training nephrologists, cardiologists, and internists, and at research workers in the field. We have tried to produce an up-to-date, in-depth review of the subject by inviting experts in clinical epidemiology, pathophysiology, and thera­ peutics to write the 18 chapters. The book is divided into three sections. The first section comprises five chapters that provide an overview of the burden of illness associated with cardiac disease in end-stage renal disease and a review of clinical epidemi­ ological aspects of various cardiac diseases that occur in renal patients. The second section discusses abnormalities of left ventricular contractility and mass, and the factors that predispose to both systolic and diastolic disorders. The importance of hypertension, anemia, hyperparathyroidism, hyper­ lipidemia, and diabetes mellitus in predisposing to these abnormalities is reviewed splendidly by researchers active in these areas. The final section concentrates on therapeutics. Data and opinion on management of congestive heart failure, cardiomyopathy, coronary artery disease, hypertension, and arrhythmias are provided. In editing this book, we have reviewed an extensive literature, but un­ fortunately we have become more aware that substantial gaps in our knowl­ edge exist. Insufficient high-quality clinical research has been undertaken xiii xiv Preface regarding the various cardiac diseases that occur in end-stage renal disease.

Inhalt

I. Epidemiology.- 1. Cardiac disease in chronic uremia: An overview.- 2. Lessons from Framingham: Cardiac disease in the general population.- 3. The natural history of myocardial disease in dialysis patients.- 4. Ischemic heart disease in chronic renal failure: Demography, epidemiology, and pathogenesis.- 5. Cardiac arrhythmias in end-stage renal disease: Prevalence, risk factors, and management.- II. Pathogenesis.- 6. Cardiac pathology in chronic renal failure.- 7. Etiology of left ventricular dysfunction in end-stage renal failure.- 8. Left ventricular dysfunction in end-stage renal disease: Echocardiographic insights.- 9. Parathyroid hormone and the myocardiopathy of chronic renal failure.- 10. Anemia and left ventricular function in end-stage renal disease.- 11. The effect of dialysis on left ventricular contractility.- 12. Atherogenesis in chronic renal failure.- 13. The heart in diabetic nephropathy.- III. Management.- 14. The management of congestive heart failure in uremic patients.- 15. The management of coronary artery disease in patients with end-stage renal disease.- 16. Therapy of hypertension in end-stage renal disease.- 17. The use of cardiovascular drugs in chronic renal failure.- 18. Dialysis therapy in patients with cardiac disease.