Aspects of Cardiovascular Burden in Pre-Dialysis Patients

BACKGROUND: Cardiovascular disease (CVD) is a major cause of death in patients with chronic renal failure (CRF). It is well recognised that dialysis patients have a high burden of factors that predispose to CVD. What is less clear is the extent of this problem in the pre-dialysis patient. This is the subject of this review. METHODS: The role of potentially correctable cardiovascular risk factors in pre-dialysis patients has been examined using published data. RESULTS: Anaemia is a major cardiovascular risk factor in patients with CRF. Partial correction of renal anaemia with recombinant human erythropoietin leads to improvements in cardiac dysfunction in such patients, such as alleviation of left ventricular hypertrophy. Secondly, malnutrition and inflammation have also been recently identified as potentially correctable cardiovascular risk factors in these patients. CONCLUSIONS: Patients continue to enter dialysis with a considerable cardiovascular burden, many having already suffered a stroke or myocardial infarction. Many risk factors, including malnutrition and inflammation, account for the increased incidence of cardiovascular events. Anaemia is common in pre-dialysis patients, and early corrective treatment may help to reduce the incidence of CVD and hence improve long-term outcome.