PTH and Marchiafava-Bignami disease: In contrast, in dialysis patients, a number of other triggers or risk factors may be identified: anemia, CKD-MBD (high parathyroid hormone [PTH] levels, hypo or hypercalcemia and hyperphosphatemia), fast electrolyte shift, chronic volume overload, inflammation, coronary artery disease, autonomic dysfunction (sympathetic hyperactivity and baroreflex dysfunction), atrial fibrillation, heart failure with systolic dysfunction, and left ventricular hypertrophy (LVH) (Figure 1) (26).