CENTRAL CHARACTERISTICS OF LEFT-VENTRICULAR STRUCTURE AND FUNCTION IN END-STAGE RENAL-DISEASE - DOES A SPECIFIC UREMIC CARDIOMYOPATHY EXIST .1.

A high cardiovascular morbidity and mortality of patients with end-stage renal disease is related to a variety of cardiovascular alterations typically encountered in dialysis patients. Contrary to the formerly accepted concept of an "uremic cardiomyopathy", it is now recognized that the majority of abnormalities in these patients are consequences of increased cardiac work- and volumeloads supporting the development of left ventricular hypertrophy and left atrial dilatation. These findings are independent from the modalities and methods of blood purification and are comparably observed in continuous ambulatory peritoneal dialysis (CAPD), short-term (3 x 4 h/week) and long-term (3 x 8 h/week) hemodialysis. Acute cardiovascular decompensation during the hemodialysis session is usually attributable to diastolic LV malfunction and impaired LV compliance rather than to systolic heart failure. Most significant hemodynamic alterations during hemodialysis are positive inotropic LV stimulation and venous as well as arterial vasodilation. Both physical and mental fitness, which tend to be impaired in dialysis patients, can be improved by regular physical exercise training.