Tag Archives: dialysis.

Introduction Chronic kidney disease (CKD) is a well-established risk factor for cardiovascular disease, associated with significantly increased morbidity and mortality.1 People with CKD often have multiple cardiovascular risk factors, including hypertension, diabetes mellitus and hyperlipidaemia. In addition to these traditional risk factors, CKD induces a pro-inflammatory state, which contributes to pathological myocardial remodelling, fibrosis, atherosclerosis and endothelial dysfunction. Further, associated disturbances in mineral metabolism including hyperphosphataemia and hyperparathyroidism lead to accelerated vascular calcification.2

End-stage renal disease (ESRD) represents a state of dysregulation of many processes including inflammation, endothelial dysfunction, vascular calcification, bone mineral metabolism, oxidative stress, autonomic balance, uraemia, volume control, coagulation, insulin resistance, and haematopoiesis. The process of haemodialysis, the most common form of renal replacement therapy, causes myocardial stunning, leading to strain and potential damage,2 and can create a pro-arrhythmic environment.3 The early dialysis period is indeed high risk, with more cardiovascular events reported within the first five months of dialysis.4 It is, therefore, not an

Introduction That renal and cardiac disease appear inseparable from an epidemiological perspective is unsurprising, since they share many risk factors, notably hypertension, diabetes and inflammation. To date, however, our focus on the disparate specialities of ‘cardiology’ and ‘nephrology’ has reinforced a perception of each system as separate. The Cardiorenal Forum (CRF) was established to challenge this perspective. The most recent meeting, last autumn, ‘Optimising care at the cardiorenal interface’ was organised by the Royal College of Physicians, the British Cardiovascular Society and the Renal Association, in association wit