A.R. NISSENSON, M.D.
To the editor: The recent paper by Capelli and Kasparian (1) elegantly defines cardiac hemodynamic abnormalities in a small group of hemodialysis patients. That death in these patients is frequently related to cardiovascular complications has been well documented (2). Undoubtedly, hypertension, pericardial disease, hyperlipidemia, hyperparathyroidism, volume overload, and anemia all contribute to this high cardiovascular mortality (3).
Of interest, however, is the possible effect of a less well-studied substance, a plasticizer (di-2-ethylhexyl phthalate [DEHP]), on myocardial function in patients undergoing hemodialysis. Ono, Tatsukawa, and Wakimoto (4) have reported accumulation of DEHP and one of its metabolites, phthalic acid, in the
NISSENSON A. Plasticizer Effect on Heart. Ann Intern Med. ;87:245. doi: 10.7326/0003-4819-87-2-245_2
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Published: Ann Intern Med. 1977;87(2):245.
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