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30 October 1998

Cardiovascular agents in renal diseases

Zofia Wańkowicz

Med Sci Monit 1998; 4(6): RA1104-1110 :: ID: 501946

Abstract

Cardiovascular diseases are main, potentially lethal, complications of renal diseases. When using cardiovascular drugs, one should take into consideration the following factors:
- the close cause-effect relationship between cardiac and renal diseases.
- polymorphism of cardiologic complications.
- multiple 'nephrogenic' factors that determine the occurrence of cardiologic complications and their resistance towards standard cardiologic agents. These factors include: hyperkaliemia and hypokaliemia, hypercalcemia and hypocalcemia, hypomagnesemia, metabolic acidosis;
- nephrogenic anemia, secondary hyperparathyroidism, lipid disturbances, hypoproteinemia, coexistent liver damage;
- modifying effect of uremia and dialysis therapy on the pharmacodynamics of cardiologic drugs.Since an ideal cardiological agent is unavailable and the correlation between renal elimination of cardiac drugs and the rate of glomerular filtration remains approximate, cardiac drug doses should be chosen individually, depending on the patients hemodynamic condition, degree of renal failure, evidence of drug cumulation and its blood concentration level. One of the tables is attached, presents cardiac drugs which may be given to patients with renal failure following maintenance dose modification. It is also worth mentioning that cardiac drugs should be administered in full saturating doses in patients with renal failure, and maintenance doses should be modified in such a way as to ensure a stable drug blood level. This may be achieved by reduction of single doses instead of time gap prolongation between standard doses. This study presents a review of cardiovascular drugs taking into consideration their potential benefits as well as potential renal damage with special reference towards: inotropic drugs, antiarrhythmic drugs, adenosine (Adenocor), ACE inhibitors, nitrates, antiplatelet and fibrinolytic drugs, as well as new cardioprotective agents. Presented here, are case reports of successfully treated severe cardiovascular complications in patients with renal failure.

Keywords: renal failure, Dialysis, Cardiovascular Agents

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