| [ Summary ] |
Cardiovascular disease (CVD) is a leading cause of mortality in dialysis patients. Dialysis patients with CVD frequently present with somewhat different clinical features than those of non-dialysis patients. Dialysis patients with acute myocardial infarction often present with subtle chest symptoms and without typical ST elevation in their electrocardiograms. Atypical presentation leads to poorer clinical outcomes in dialysis patients with CVD. Diagnosis of CVD in dialysis patients, therefore, should be made with a lower clinical threshold. Clinical evidence of CVD in dialysis patients is often not sufficient and undertreatment for dialysis patients with CVD has been reported. Dialysis patients seems to have relatively specific cardiovascular risk factors, like vascular calcification, chronic inflammation and sleep disorders, and management for these risk factors remains to be elucidated. Dialysis patients with CVD more frequently present with sudden death and, unlike the general population, sudden death in dialysis patients may be due not only to cardiac ischemia but also to cardiac hypertrophy and fibrosis. Good clinical evidence for CVD in dialysis patients should be established, especially in Japanese dialysis patients. |