Congestive heart failure due to systolic dysfunction: the Cinderella of cardiovascular management in dialysis patients.

Cardiac disease is common in dialysis patients. Survival is poorest in the subgroup with systolic dysfunction (pump failure). Audits show that cardiovascular management of dialysis patients in general, and treatment of congestive heart failure (CHF) specifically, is generally not in agreement with recommendations based on evidence obtained from controlled trials, admittedly in nonrenal patients. The pathophysiology underlying CHF and the rationale underlying interventions are discussed in an effort to heighten awareness of this important clinical problem in the dialysis community.