Cardiovascular disturbances in hemodialysis patients: The importance of volume overload

This review concentrates on the pathophysiology of cardiovascular changes in hemodialysis and attempts to identify regions deserving more attention. Some of the links constituting the volume/blood pressure relationship still await further elucidation. Whether volume retention is an independent risk factor has not yet been completely analysed. The existence of a specific toxic cardiomyopathy is debated, since a similar picture can result from long-standing hypertension and volume expansion. The relative contribution of plasma renin to the hypertension of many HD patients is still unknown. Consequently the place of converting enzyme inhibition in the treatment of these patients has yet to be established. Taken together the evidence available indicates that better volume control could considerably improve cardiovascular morbidity in a large part of the HD population