| [ Summary ] |
The prognosis for dialysis patients with congestive heart failure (CHF) has been so poor that early detection of left ventricular (LV) dysfunction and appropriate intervention for the underlining heart diseases are imperative. Echocardiography and determination of plasma BNP concentrations provide us with important homodynamic and prognostic information. As coronary artery disease is a leading underlying disease in this population, coronary angiography should be performed if there are no contraindications. Pathological examination of biopsy specimens from the LV wall may reveal some specific myocardial disorders. Initial treatment of CHF includes removal of excess-water using dialysis or continuous hemofiltration, occlusion of the access-shunt, and infusion of cathecholamine and/or nitroglycerine. Afer stabilization, introduction for beta-blockers should be considered in patients with LV systolic dysfunction. Our goal for beta-blocker therapy is to achive levels of less than 200pg/ml in the plasma BNP concentration. High blood pressure, hyperglycemia, anemia, and hypo-albuminemia are important targets for intervention in order to avoid further episodes of CHF. Furthermore, definitive therapy, such as coronary revascularization and valve replacement, should be considered if these are indicated. |