CARDIAC DYSFUNCTION IN CHRONIC UREMIA

Transcription

1 CARDIAC DYSFUNCTION IN CHRONIC UREMIA

2 TOPICS IN RENAL MEDICINE Vittorio E. Andreucci, Series Editor Titles in the series 1. VE Andreucci, The Kidney in Pregnancy. 2. AR Clarkson, IgA Nephropathy. 3. V Cambi, Short Dialysis. 4. RN Fine, Chronic Ambulatory Peritoneal Dialysis (CAPD) and Chronic Cycling Peritoneal Dialysis (CCPD) in Children. 5. CYC Pak, Renal Stone Disease. 6. CE Mogensen, The Kidney and Hypertension in Diabetes Mellitus. 7. S Giovannetti, The Nutritional Treatment of Chronic Renal Failure. S. VE Andreucci, Vascular and Peritoneal Access for Dialysis. 9. A Spitzer and ED Avner, Inheritance of Kidney and Urinary Tract Diseases. 10. PS Parfrey andjd Harnett, eds., Cardiac Dysfunction in Chronic Uremia.

3 CARDIAC DYSFUNCTION IN CHRONIC UREMIA EDITED BY PATRICK S. PARFREY The Health Sciences Centre Memorial University of Newfoundland St. John's, Newfoundland, Canada and JOHN D. HARNETT The Health Sciences Centre Memorial University of Newfoundland St. John's, Newfoundland, Canada... " SPRINGER SCIENCE+BUSINESS MEDIA, LLC

4 Library of Congress Cataloging-in-Publication Data Cardiac dysfunction in chronic uremia/editors, Patrick S. Parfrey and John D. Harnett. p. cm.-(topics in renal medicine; 10) Includes bibliographical references and index. ISBN ISBN (ebook) DOI / Heart-Muscle-Diseases. 2. Chronic renal failure Complications and sequelae. 3. Uremia-Complications and sequelae. 1. Parfrey, Patrick S. II. Harnett, John D. III. Series. [DNLM: 1. Heart Diseases-epidemiology. 2. Heart Diseasesetiology. 3. Heart Diseases-therapy. 4. Kidney Failure, Chroniccomplications. W1 1054R v. lo/wj 342 C267j RC685.M9C '2-dc20 DNLMIDLC for Library of Congress CIP Copyright 1992 by Springer Science+Business Media New York Originally published by Kluwer Academic Publishers in 1992 Softcover reprint of the hardcover Ist edition 1992 AII rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, mechanical, photocopying, recording, or otherwise, without the prior written permission ofthe publisher, Springer Science+Business Media, LLC. Prin/ed on acidjree paper.

5 CONTENTS Contributing Authors Preface xiii vii I. EPIDEMIOLOGY 1. Cardiac disease in chronic uremia: An overview 3 PHILIP J. HELD, NATHAN W. LEVIN, AND FRIEDRICH K. PORT 2. Lessons from Framingham: Cardiac disease in the general population 19 ROBERT N. FOLEY AND PATRICK S. PARFREY 3. The natural history of myocardial disease in dialysis patients 39 PATRICK S. PARFREY AND JOHN D. HARNETT 4. Ischemic heart disease in chronic renal failure: Demography, epidemiology, and pathogenesis 53 STEPHEN G. ROSTAND AND EDWIN A. RUTSKY 5. Cardiac arrhythmias in end-stage renal disease: Prevalence, risk factors, and management 67 VOLKER WIZEMANN AND WILFRIED KRAMER II. PATHOGENESIS 6. Cardiac pathology in chronic renal failure 85 GROVER M. HUTCHINS 7. Etiology ofleft ventricular dysfunction in end-stage renal failure 105 RAINER NOWACK, ALEXANDER P. MANDELBAUM, AND EBERHARD RITZ v

6 vi Contents 8. Left ventricular dysfunction in end-stage renal disease: Echocardiographic insights 117 GERARD M. LONDON AND FRANC;:OISE FABIANI 9. Parathyroid hormone and the myocardiopathy of chronic renal failure 139 SHAUL G. MASSRY, MIROSLAW SMOGORZEWSKI, AND ALESSANDRA F. PERNA 10. Anemia and left ventricular function in end-stage renal disease 161 ALLAN D. SNIDERMAN, JONATHAN SILBERBERG, SARAH PRICHARD, AND PAUL E. BARRE 11. The effect of dialysis on left ventricular contractility 171 BIFF F. PALMER AND WILLIAM L. HENRICH 12. Atherogenesis in chronic renal failure 187 R. JEAN SHAPIRO 13. The heart in diabetic nephropathy 205 LEIF THUESEN, JENS SANDAHL CHRISTIANSEN, AND CARL ERIK MOGENSEN m. MANAGEMENT 14. The management of congestive heart failure in uremic patients 221 JOHN D. HARNETT AND PATRICK S. PARFREY 15. The management of coronary artery disease in patients with end-stage renal disease 231 EDWIN A. RUTSKY AND STEPHEN G. ROSTAND 16. Therapy of hypertension in end-stage renal disease 247 LOUISE F. ROY AND FRANS H.H. LEENEN 17. The use of cardiovascular drugs in chronic renal failure 267 SUZANNE K. SWAN AND WILLIAM M. BENNETT 18. Dialysis therapy in patients with cardiac disease 283 M. HENRY GAULT AND BRENDAN J. BARRETT Index 303

7 CONTRIBUTING AUTHORS Paul E. Barre Associate Professor of Medicine and Chief of Hemodialysis Division of Nephrology Royal Victoria Hospital, McGill University Montreal, Quebec H3A tat, Canada Brendan J. Barrett Research Fellow, Division of Nephrology The Health Sciences Centre, Memorial University of Newfoundland St. John's, Newfoundland AtB 3V6, Canada William M. Bennett Professor of Medicine and Pharmacology Co-Head, Division of Nephrology and Hypertension Oregon Health Sciences University School of Medicine Portland, Oregon 9720t, USA Jens Sandahl Christiansen Second Clinic of Internal Medicine University of Aarhus Aarhus, Denmark vii

8 viii Contributing authors Fran~oise Fabiani Unite Cardiovasculaire Hopital PEAN, 11 rue de la Sante F Paris, France Robert N. Foley Renal Resident, Division of Nephrology Health Sciences Centre, Memorial University of Newfoundland St. John's, Newfoundland AlB 3V6, Canada M. Henry Gault Professor of Medicine and Staff Nephrologist Division of Nephrology Health Sciences Centre, Memorial University of Newfoundland St. John's, Newfoundland AlB 3V6, Canada John D. Harnett Assistant Professor of Medicine and Staff Nephrologist Division of Nephrology Health Sciences Centre, Memorial University of Newfoundland St. John's, Newfoundland AlB 3V6, Canada Philip J. Held Director, United States Renal Data System The Urban Institute 2100 M Street, NW Washington, DC 20037, USA William L. Henrich Professor of Internal Medicine University of Texas Southwestern Medical Centre Associate Chief of Staff for Research and Development Veterans Administration Medical Center Dallas, Texas 75216, USA Grover M. Hutchins Professor of Pathology Department of Pathology The John Hopkins Medical Institutions Baltimore, Maryland 21205, USA Wilfried Kramer Georg Haas Dialysezentrum, University of Giessen Johann Sebastian Bach Strasse 40 D-6300 Giessen, Germany

9 Contributing authors ix Frans H. H. Leenen Professor of Medicine and Pharmacology, Hypertension Unit University of Ottawa Heart Institute Ottawa Civic Hospital Ottawa, Ontario K1Y 4E9, Canada Nathan W. Levin Professor of Medicine and Chief, Division of Nephrology and Hypertension Beth Israel Medical Center 1st Avenue at 16th St. New York, NY 10003, USA Gerard M. London c.h. MANHES 8, Grande Rue F Fleury Merogis FRANCE Shaul G. Massry Professor of Medicine and Chief, Division of Nephrology University of Southern California School of Medicine, 2025 Zonal Ave. Los Angeles, California 90210, USA Alexander P. Mandelbaum Sektion Nephrologie, Klinikum der Universitat Heidelberg Ruperto Carola University D-6900 Heidelberg, Germany Carl Erik Mogensen Professor of Medicine 11 University Clinical of Internal Medicine University of Aarhus Aarhus, Denmark Rainer Nowack Sektion Nephrologie, Klinikum der Universitat Heidelberg Ruperto Carola University D-6900 Heidelberg, German BiffF. Palmer Assistant Professor ofinternal Medicine Department of Internal Medicine University of Texas Southwestern Medical Center Associate Medical Director of Renal Transplantation Portland Memorial Hospital Dallas, Texas 75216, USA

10 x Contributing authors Patrick S. Parfrey Associate Professor of Medicine and Chief, Division of Nephrology The Health Sciences Centre, Memorial University of Newfoundland St. John's, Newfoundland AlB 3V6, Canada Alessandra F. Perna Division of Nephrology University of Southern California School of Medicine, 2025 Zonal A venue Los Angeles, California 90210, USA Friedrich K. Port University of Michigan Medical School Medical Sciences Building 1 Ann Arbor, Ml , USA Sarah Prichard Associate Professor and Chief of Peritoneal Dialysis Division of Nephrology Royal Victoria Hospital, McGill University Montreal, Quebec H3A lal, Canada Eberhard Ritz Professor of Medicine and Chief, Sektion Nephrologie Klinikum der Universitat Heidelberg, Ruperto Carola University D-6900 Heidelberg, Germany Stephen G. Rostand Professor of Medicine and Assistant Chief of Staff University of Alabama Hospital, Division of Nephrology Birmingham, Alabama 35294, USA Louise F. Roy Assistant Professor of Medicine, Andre-Viallet Clinical Research Centre Saint Luc Hospital, University of Montreal Montreal, Quebec HZX 1 Pl, Canada Edwin A. Rutsky Professor of Medicine and Director of Dialysis Facilities Division of Nephrology, University of Alabama Birmingham, Alabama 35294, USA R. Jean Shapiro Assistant Professor of Medicine, Department of Medicine University Hospital-UBC Site, University of British Columbia Vancouver, British Columbia VGT lw5, Canada

11 Contributing authors xi Jonathan Silberberg Lecturer in Medicine, Department of Medicine University of Newcastle Newcastle-Upon-Tyne NEl 7RU, England Miroslaw Smogorzewski Division of Nephrology University of Southern California School of Medicine, 2025 Zonal Ave Los Angeles, California 90210, USA Allan D. Sniderman Professor of Medicine and Chief, Division of Cardiology Royal Victoria Hospital, McGill University Montreal, Quebec H3A lal, Canada Suzanne K. Swan Clinical Instructor, Division of Nephrology and Hypertension Oregon Health Sciences University Portland, Oregon 97201, USA Leif Thuesen Department of Cardiology Shejby Hospital, University of Aarhus Aarhus, Denmark Volker Wizemann Professor of Medicine, Georg-Haas-Dialysezentrum University of Giessen Johann Sebastian Bach Strasse 40 D-6300 Giessen, Germany

12 PREFACE Cardiac disease is the major cause of death in dialysis patients, accounting for over one third of deaths. This book focuses on myocardial function and dysfunction in chronic uremia. It is aimed at practicing and training nephrologists, cardiologists, and internists, and at research workers in the field. We have tried to produce an up-to-date, in-depth review of the subject by inviting experts in clinical epidemiology, pathophysiology, and therapeutics to write the 18 chapters. The book is divided into three sections. The first section comprises five chapters that provide an overview of the burden of illness associated with cardiac disease in end-stage renal disease and a review of clinical epidemiological aspects of various cardiac diseases that occur in renal patients. The second section discusses abnormalities of left ventricular contractility and mass, and the factors that predispose to both systolic and diastolic disorders. The importance of hypertension, anemia, hyperparathyroidism, hyperlipidemia, and diabetes mellitus in predisposing to these abnormalities is reviewed splendidly by researchers active in these areas. The final section concentrates on therapeutics. Data and opinion on management of congestive heart failure, cardiomyopathy, coronary artery disease, hypertension, and arrhythmias are provided. In editing this book, we have reviewed an extensive literature, but unfortunately we have become more aware that substantial gaps in our knowledge exist. Insufficient high-quality clinical research has been undertaken xiii

13 xiv Preface regarding the various cardiac diseases that occur in end-stage renal disease. The pathogenesis of many of these disorders is still uncertain, and management of cardiac problems is often based on opinion rather than science. Hopefully, this book will bring you up-to-date and help you understand some of the clinical problems that occur in chronic uremia. However, our biggest hope is that the book will identify some of the problems that remain in the area of cardiac dysfunction in end-stage renal disease and will stimulate you to solve some of them.