Cardiovascular



Cardiovascular disease is one of the most com­mon causes of death in patients with ESRD. The incidence of coronary artery disease in ESRD pa­tients is significant and may be related to the pres­ence of hypertension, glucose intolerance, and/or the abnormalities in lipid metabolism. Renal dis­ease may also result in accelerated arterosclerotic disease and a form of cardiomyopathy. Ingestion of sodium and water in excess of the excretory capacity of the kidney can result in expansion of the extracellular fluid volume. Tolerance to ex­pansion of the extracellular fluid volume is de­pendent, in part, on cardiac function. The clinical manifestations of expansion of the extracellular fluid volume include hypertension, congestive heart failure, and peripheral edema.

Involvement of the pericardium is common in ESRD patients. Clinical manifestations may in­clude pericarditis with pain, fever, and a pericar­dial friction rub, or pericardial effusion with or without clinically apparent pericarditis. Pericar­dial tamponade and constrictive pericarditis are less common manifestations but are more life-threatening. Pericarditis occurs in two distinct clinical situations. In the newly diagnosed uremic patient or in patients who have been inadequately dialyzed, institution of regular dialytic treatment results in resolution of the pericarditis. Pericar­ditis can also arise in patients who are already established on dialysis and who appear to be welldialyzed. In this circumstance, increasing the number or duration of dialytic treatments does not hasten the resolution of the pericarditis. Cardiac tamponade requires immediate drainage of the pericardial fluid. Constrictive pericarditis re­quires surgical intervention.





Cardiovascular