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Hidden risks associated with conventional short intermittent hemodialysis:A call for action to mitigate cardiovascular risk and morbidity

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World Journal of Nephrology 2022年第2期11卷 39-57页

作者： Bernard Canaud Jeroen P Kooman Nicholas M Selby Maarten Taal Andreas Maierhofer Pascal Kopperschmidt Susan Francis Allan Collins peter kotanko Global Medical Office Fresenius Medical CareBad Homburg 61352Germany Department of Nephrology Montpellier UniversityMontpellier 34000France Department of Internal Medicine Maastricht UniversityMaastricht 6229 HXNetherlands Centre for Kidney Research and Innovation Academic Unit for Translational Medical SciencesSchool of MedicineUniversity of NottinghamDerby DE223DTUnited Kingdom Global Research Development Fresenius Medical CareSchweinfurt 97424Germany University of Nottingham Nottingham NG72RDUnited Kingdom Renal Research Institute Icahn School of Medicine at Mount SinaiNew YorkNY 10065United States

The development of maintenance hemodialysis(HD)for end stage kidney disease patients is a success story that continues to save many ***,intermittent renal replacement therapy is also a source of recurrent stress for *** thrice weekly short HD is an imperfect treatment that only partially corrects uremic abnormalities,increases cardiovascular risk,and exacerbates disease *** cycles of fluid loading associated with cardiac stretching(interdialytic phase)and then fluid unloading(intradialytic phase)likely contribute to cardiac and vascular *** unphysiologic treatment profile combined with cyclic disturbances including osmotic and electrolytic shifts may contribute to morbidity in dialysis patients and augment the health burdenof treatment. As such, HD patients are exposed to multiple stressors including cardiocirculatory,inflammatory, biologic, hypoxemic, and nutritional. This cascade of events can be termed thedialysis stress storm and sickness syndrome. Mitigating cardiovascular risk and morbidityassociated with conventional intermittent HD appears to be a priority for improving patientexperience and reducing disease burden. In this in-depth review, we summarize the hidden effectsof intermittent HD therapy, and call for action to improve delivered HD and develop treatmentschedules that are better tolerated and associated with fewer adverse effects.

关键词： End stage kidney disease Cardiovascular mortality Dialytic morbidity Circulatory stress Biologic storm Dialysis sickness Personalized medicine

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