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Hepato‐splanchnic circulatory stress: An important effect of hemodialysis
Author(s) -
Grant Claire J.,
Huang ShihHan S.,
McIntyre Chris W.
Publication year - 2019
Publication title -
seminars in dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 78
eISSN - 1525-139X
pISSN - 0894-0959
DOI - 10.1111/sdi.12782
Subject(s) - medicine , splanchnic , circulatory system , hemodialysis , pathogenesis , pathophysiology , gastrointestinal tract , splanchnic circulation , circulatory collapse , intensive care medicine , dialysis , dysbiosis , disease , gastroenterology , blood flow
Abstract The gastro‐intestinal tract is being increasingly recognized as the site of key pathophysiological processes in the hemodialysis patient. Intestinal dysbiosis, increased intraluminal toxin production, and increased intestinal permeability are commonly observed processes which contribute to the pathogenesis of cardiovascular disease and thus elevated mortality. The acute circulatory effects of dialysis itself may contribute significantly to the development of gastrointestinal dysfunction as a result of both local and distant effects. Additionally, the liver, a relatively unknown entity in this process, has a substantial role as a functional barrier between the portal and systemic circulation and in the metabolism of pathogenic gut‐derived uremic toxins. Here we summarize the evidence for acute gastro‐intestinal and hepatic effects of hemodialysis and identify gaps in knowledge to date which require further study.