Management of Patient Care in Hemodialysis While Focusing on Cardiovascular Disease Events and the Atypical Role of Hyper- and/or Hypotension: A Systematic Review.
Amjad KhanAmer Hayat KhanAzreen Syazril AdnanSyed Azhar Syed SulaimanSiew Hua GanIrfanullah KhanPublished in: BioMed research international (2016)
Background. Hemodialysis related hemodynamic instability is a major but an underestimated issue. Moreover, cardiovascular events are the leading cause of morbidity and mortality associated with blood pressure in hemodialysis patients. However, there have been many controversies regarding the role and management of hyper- and/or hypotension during hemodialysis that needs to be addressed. Objective. To critically review the available published data on the atypical role of hyper- and/or hypotension in cardiovascular associated morbidity and mortality in patients on hemodialysis and to understand the discrepancies in this context. Methods. A comprehensive search of literature employing electronic as well as manual sources and screening 2783 papers published between Jan 1980 and Oct 2015 was conducted to collect, identify, and analyze relevant information through peer-reviewed research articles, systematic reviews, and other published works. The cardiovascular events, including accelerated atherosclerotic cardiovascular disease (ASCVD), stroke, heart failure, myocardial infarction, myocardial ischemia, and stress induced myocardial dysfunction, leading to death were considered relevant. Results. A total of 23 published articles met the inclusion criteria and were included for in-depth review and analysis to finalize a comprehensive systematic review article. All the studies showed a significant association between the blood pressure and cardiovascular disease events in hemodialysis patients. Conclusions. Both intradialytic hypertension/hypotension episodes are major risk factors for cardiovascular mortality with a high percentage of probable causality; however, clinicians are faced with a dilemma on how to evaluate blood pressure and treat this condition.
Keyphrases
- cardiovascular events
- cardiovascular disease
- end stage renal disease
- blood pressure
- meta analyses
- peritoneal dialysis
- chronic kidney disease
- systematic review
- stress induced
- heart failure
- left ventricular
- hypertensive patients
- coronary artery disease
- heart rate
- randomized controlled trial
- type diabetes
- cardiovascular risk factors
- atrial fibrillation
- palliative care
- optical coherence tomography
- newly diagnosed
- oxidative stress
- electronic health record
- tyrosine kinase
- big data
- ejection fraction
- prognostic factors
- cardiac resynchronization therapy
- diabetic retinopathy
- risk factors
- blood glucose
- optic nerve
- health information
- glycemic control
- patient reported
- insulin resistance