Update on HD-Induced Multiorgan Ischemia: Brains and Beyond.

Hemodialysis (HD) is a life-saving treatment for patients with kidney failure. However, patients requiring HD have a 10-20 times higher risk of cardiovascular (CV) morbidity and mortality than that of the general population. Patients encounter complications such as episodic intradialytic hypotension (IDH), abnormal perfusion to critical organs (heart, brain, liver, and kidney) and damage to vulnerable vascular beds. Recurrent conventional HD exposes patients to multiple episodes of circulatory stress, exacerbating and being aggravated by microvascular endothelial dysfunction. This promulgates progressive injury that leads to irreversible multiorgan injury and the well documented increased incidence of CV disease and premature death. This review aims to examine the underlying pathophysiology of HD-related vascular injury and to consider a range of therapeutic approach to improving outcomes set within this evolved rubric.