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透析为多数心脏病人是安全的; 应该考虑钾水平

Lynn Shapiro, Writer | July 10, 2009
With careful monitoring,
a new study suggests
dialysis may be safe
for heart patients
Dialysis treatments do not affect the heart health of most kidney disease patients who have had a heart attack, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN). Since cardiovascular disease is the most common cause of death in kidney disease patients, the findings are good news for individuals who need the treatments, the researchers say.

The study pointed out that except for those patients who have had severe heart attacks and those who have high potassium levels, or whose levels drop precipitously after dialysis, this crucial procedure need not be delayed.

People with even mild forms of kidney disease have an elevated risk of heart attack, the authors write. Those with end-stage renal disease (ESRD) are particularly vulnerable and often experience a heart attack while undergoing kidney disease treatments such as dialysis.

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To investigate this issue, Dr. George Coritsidis, (Elmhurst/Queens Hospital Center/Mount Sinai School of Medicine), and his colleagues reviewed the medical charts of 131 ESRD patients who experienced an MI while they were on dialysis. They looked to see if the timing of dialysis following an MI had any effect on patients' heart health afterward.

About half of the patients received dialysis within the first 24 hours of their heart attack. A quarter received dialysis 24 to 48 hours after their heart attack, and a quarter received dialysis more than 48 hours after.

Seriousness of CVD and Potassium Levels Key

The researchers found no link between the timing of dialysis treatments and cardiac symptoms such as chest pains or emergency room admissions. A similar number of patients in each of the three groups experienced cardiac symptoms. However, in these patients, the investigators identified several predictors that might indicate which dialysis patients have a particularly high risk of having a heart attack following dialysis. These include the seriousness of the patient's condition, prior heart disease, high pre-dialysis potassium blood levels, and a large drop in potassium blood levels after dialysis.

"In conclusion, our study does not indicate that timing of dialysis poses a risk. What may be of greater importance is the potassium status, its treatment, and the severity of the patients' condition on admission," the authors wrote.

Source: The American Society of Nephrology (ASN)