Nephrologists Need Experience in Cardiac Care

In 1998, the American Journal of Kidney Disease sounded a clarion call with the following title on the cover of their journal, “Cardiovascular Disease, An ESRD Epidemic.” ¹ Their call was well grounded because cardiovascular disease (CVD) is the leading cause of morbidity and mortality in patients with end-stage renal disease (ESRD).^1-2 It accounts for half of the deaths and a third of hospitalizations of dialysis patients.⁴

The statistics are alarming. “Cardiovascular collapse is a major cause of complications during hemodialysis treatments.” ¹ Congestive heart failure (CHF) in ESRD patients results from cardiac overload, anemia, severe hypertension and cardiac dysfunction. CVD mortality rates are about 30 times that of the general population, and in adolescents, CVD mortality rates are over 1,000 times that of their age-related peers.⁴

Nephrologists are now being asked to assume a greater awareness of the cardiovascular complications of their patients. Proactive cardiovascular management of dialysis patients has become a major consideration and challenge in hemodialysis care. But are nephrologist prepared?

In the July 2016 issue of Nephrology News and Issues,⁵ Frank Maddux, MD, Fresenius Medical Care’s chief medical officer, notes that nephrology fellows do not receive training in chronic disease categories such as cardiovascular disease. He suggests that by developing a new approach for the nephrologist that would include cardiac care experience, the nephrology specialty could experience a renaissance. ⁴

References:

1 Cardiovascular Disease, An ESRD Epidemic. Am J Kid Dis 1998; 32(5): Suppl 3.

2 MacRae JM et al, “The Cardiovascular Effects of Arteriovenous Fistulas in Chronic Kidney Disease: A Cause for Concern?” Sem in Dialysis 2006; 19(15): 349-352. (Transonic Reference # HD7337A)

3 Locatelli F et al, “Cardiovascular Disease in Chronic Renal Failure; the Challenge Continues”” Nephrol Dial Transplant 2000; 15(Suppl 5): 69-80. (Transonic Reference # HD9643R)

4 Hooper DK et al, “The quality of cardiovascular disease care for adolescents with kidney disease: a Midwest Pediatric Nephrology Consortium study,” Pediatr Nephrol. 2013 Jun;28(6):939-49. Nefrologia. 2015 May-Jun;35(3):234-45. (Transonic Reference HD10619AHR)

5 Nephrology News and Issues. July 2016, page 39