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Lin C, Ge Q, Wang L, Zeng P, Huang M, Li D. Predictors, prevalence and prognostic role of pulmonary hypertension in patients with chronic kidney disease: a systematic review and meta-analysis. Ren Fail 2024; 46:2368082. [PMID: 38938193 PMCID: PMC11216249 DOI: 10.1080/0886022x.2024.2368082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 06/08/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND To estimate the predictors, prevalence and prognostic role of pulmonary hypertension (PH) in patients with chronic kidney disease (CKD) using meta-analysis. METHODS The PubMed, EmBase, and the Cochrane library were systematically searched for eligible studies from inception till May 2024. All of pooled analyses were performed using the random-effects model. RESULTS Fifty observational studies involving 17,558 CKD patients were selected. The prevalence of PH in CKD patients was 38% (95% confidence interval [CI]: 33%-43%), and the prevalence according to CKD status were 31% (95% CI: 20%-42%) for CKD (I-V), 39% (95% CI: 25%-54%) for end stage kidney disease (ESKD) (predialysis), 42% (95% CI: 35%-50%) for ESKD (hemodialysis), and 26% (95% CI: 19%-34%) for renal transplant. We noted the risk factors for PH in CKD included Black individuals (relative risk [RR]: 1.39; 95% CI: 1.18-1.63; p < 0.001), chronic obstructive pulmonary disease (RR: 1.48; 95% CI: 1.21-1.82; p < 0.001), cardiovascular disease history (RR: 1.62; 95% CI: 1.05-2.51; p = 0.030), longer dialysis (RR: 1.70; 95% CI: 1.18-2.46; p = 0.005), diastolic dysfunction (RR: 1.88; 95% CI: 1.38-2.55; p < 0.001), systolic dysfunction (RR: 3.75; 95% CI: 2.88-4.87; p < 0.001), and grade 5 CKD (RR: 5.64; 95% CI: 3.18-9.98; p < 0.001). Moreover, PH in CKD patients is also associated with poor prognosis, including all-cause mortality, major cardiovascular events, and cardiac death. CONCLUSION This study systematically identified risk factors for PH in CKD patients, and PH were associated with poor prognosis. Therefore, patients with high prevalence of PH should be identified for treatment.
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Affiliation(s)
- Chunlong Lin
- Department of Respiratory and Critical Care Medicine, Yueyang municipal Hospital of Hunan Normal University, Hunan, China
| | - Qilong Ge
- Department of Respiratory and Critical Care Medicine, Yueyang municipal Hospital of Hunan Normal University, Hunan, China
| | - Lei Wang
- Department of Respiratory and Critical Care Medicine, Yueyang municipal Hospital of Hunan Normal University, Hunan, China
| | - Pan Zeng
- Department of Respiratory and Critical Care Medicine, Yueyang municipal Hospital of Hunan Normal University, Hunan, China
| | - Mingmin Huang
- Department of Respiratory and Critical Care Medicine, Yueyang municipal Hospital of Hunan Normal University, Hunan, China
| | - Dan Li
- Department of Respiratory and Critical Care Medicine, Yueyang municipal Hospital of Hunan Normal University, Hunan, China
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Wang C, Meng L, Cheng XY, Chen YQ. Assessment of right ventricular dysfunction and its association with excess risk of cardiovascular events in patients undergoing maintenance hemodialysis. Ren Fail 2024; 46:2364766. [PMID: 38874087 PMCID: PMC11182060 DOI: 10.1080/0886022x.2024.2364766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 05/31/2024] [Indexed: 06/15/2024] Open
Abstract
AIMS Recent accumulating evidence has recently documented a significant prevalence of right ventricular dysfunction (RVD) in end-stage renal disease (ESRD) patients. Tricuspid annular plane systolic excursion (TAPSE)/pulmonary-artery systolic pressure (PASP) ratio assessed with echocardiography might be a useful clinical index of right ventricular (RV) -pulmonary arterial (PA) coupling. The current study aimed to investigate the value of the TAPSE/PASP ratios in patients on maintenance hemodialysis (MHD). METHODS We studied 83 times echocardiographic tests from 68 patients with MHD. The associations of TAPSE/PASP ratios with echocardiography variables, clinical characteristics, and biochemical parameters were analyzed, as well as the associations of TAPSE/PASP ratios with odds of all-cause mortality, cardiovascular disease (CVD) events and frequent intermittent dialysis hypotension (IDH). RESULTS Correlation analysis showed TAPSE/PASP ratios positively correlated with LVEF and negatively correlated with E/A and E/e' values. For clinical and biochemical parameters, TAPSE/PASP ratios negatively correlated with BNP, NT-proBNP, age, CRP, and average interdialysis weight gain (ΔBW) and positively correlated with albumin. Logistic regression analysis, which induced the TAPSE/PASP ratio as a continuous variable (per 0.1 mm/mmHg increase), identified that the TAPSE/PASP ratio was associated with decreased CVD events (OR 0.386 [95% CI 0.231-0.645], p < 0.001) and frequent IDH odds (OR 0.571 [95% CI 0.397-0.820], p = 0.002). Moreover, the TAPSE/PASP ratio independently predicted CVD events (adjusted HR 0.539 [95% CI 0.391-0.743], p < 0.001) during a follow-up period of 12 months. CONCLUSIONS RVD, assessed by echocardiography TAPSE/PASP ratio, was found to be associated with increased risks of CVD events and frequent IDH in patients with MHD.
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Affiliation(s)
- Chen Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment, (Peking University), Ministry of Education, Beijing, China
| | - Li Meng
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment, (Peking University), Ministry of Education, Beijing, China
| | - Xu-Yang Cheng
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment, (Peking University), Ministry of Education, Beijing, China
| | - Yu-Qing Chen
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment, (Peking University), Ministry of Education, Beijing, China
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Daralammouri Y, Qaddumi J, Ayoub K, Abu-Hantash D, Al-Sadi MA, Ayaseh RM, Azamtta M, Sawalmeh O, Hamdan Z. Pathological right ventricular changes in synthesized electrocardiogram in end-stage renal disease patients and their association with mortality and cardiac hospitalization: a cohort study. BMC Nephrol 2022; 23:79. [PMID: 35209873 PMCID: PMC8867672 DOI: 10.1186/s12882-022-02707-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/11/2022] [Indexed: 11/20/2022] Open
Abstract
Background Right ventricular (RV) function is an important prognostic predictor for end-stage renal disease (ESRD) patients. Non-invasive evaluation of RV function by simple electrocardiogram (ECG) is not yet evident. The purpose of this article was to investigate the presence and association of pathological right ventricular changes in synthesized ECG with cardiac hospitalization and mortality. Methods A prospective cohort study of 137 ESRD patients (mean age: 56 years) were recruited from the hemodialysis unit in An-Najah National University Hospital, Nablus, Palestine. Synthesized ECG was done right before the hemodialysis (HD) session. The pathological right ventricular changes were recorded for each patient. The relationship between pathological RV changes and mortality, cardiac and non-cardiac hospitalization was assessed through a 6-months follow-up period. Results Right ventricular Q wave was found in 2.2% of patients, while right ventricular ST elevation was found in 0.7% of patients, and right ventricular negative T wave was found in 0.7% of patients. During the 6-month period of follow-up, 36 (26.3%) patients were hospitalized, nine patients (6.6%) due to cardiac causes. A total of 8 (5.83%) patients died, out of those 4 patients (2.91%) due to cardiac causes. Using Fisher’s exact test, there was a significant association between pathological abnormalities in synthesized ECG and hospitalization among hemodialysis patients, (p = 0.047). Pathological changes in synthesized ECG were less prevalent in non-cardiac hospitalizations than in cardiac hospitalizations. Conclusions The presence of pathological RV synthesized ECG changes can predict cardiac hospitalization in ESRD patients. Synthesized ECG is a good available tool that can be easily performed in ESRD patients. To determine whether Synthesized ECG can be used as a screening tool for pathological RV changes in a dialysis patients, more research with a larger number of patients and a longer follow-up period is required.
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Affiliation(s)
- Yunis Daralammouri
- Department of Cardiology, An-Najah National University Hospital, Nablus, Palestine. .,Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
| | - Jamal Qaddumi
- Public Health Department, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Khubaib Ayoub
- Department of Internal Medicine, An-Najah National University Hospital, Nablus, Palestine
| | - Doaa Abu-Hantash
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Mai Arafat Al-Sadi
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Rofayda M Ayaseh
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Murad Azamtta
- Department of Cardiology, An-Najah National University Hospital, Nablus, Palestine
| | - Osama Sawalmeh
- Department of Internal Medicine, An-Najah National University Hospital, Nablus, Palestine
| | - Zakaria Hamdan
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.,Department of Internal Medicine, An-Najah National University Hospital, Nablus, Palestine.,Nephrology Unit, An-Najah National University Hospital, Nablus, Palestine
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Carbayo J, Abad S, Verde E, Muñoz de Morales A, Gonzalez-Rojas A, Acosta A, Mijaylova A, Bascuñana A, Vega A, Goicoechea M. Body composition and ventricular function in hemodialysis patients. Semin Dial 2021; 34:285-291. [PMID: 33609406 DOI: 10.1111/sdi.12955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 12/29/2020] [Indexed: 11/30/2022]
Abstract
There is no evidence about the potential role of body composition on cardiovascular mortality in dialysis patients. The aim of this study was to assess the relationship between body composition and changes in ventricular function. We conducted an observational study over a population of 78 patients on chronic hemodialysis. A transthoracic echocardiogram and a bioimpedance were performed at the beginning and at the end of the study. The mean follow-up time was 30.6 months. Patients who had a higher fat tissue index (FTI > 9.20 kg/m2 ) experienced a worsening in right and left ventricular function. They developed a greater fall in tricuspid annular plane systolic excursion (TAPSE) (-1 ± 4.3 mm) and left ventricular ejection fraction (LVEF)(-4.2 ± 6.8%), compared to those with lower FTI (p = 0.032 and p = 0.045, respectively). No associations were found between any other echocardiography or body composition parameters and overall mortality. Patients with right ventricular dysfunction (determined as TAPSE) experienced a tendency to higher mortality rate along the study (HR for mortality of 13.5 (95% CI, 1.1-166.7; p = 0.041)]. A higher fat tissue index could be associated with a deleterious effect over right and left ventricular function in dialysis patients.
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Affiliation(s)
- Javier Carbayo
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Soraya Abad
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Eduardo Verde
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Angela Gonzalez-Rojas
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Adriana Acosta
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Antonia Mijaylova
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Arturo Bascuñana
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Almudena Vega
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Marian Goicoechea
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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The relation between body fluid composition and echocardiographic tissue Doppler measurements in patients with end-stage renal disease. Int Urol Nephrol 2020; 52:2189-2195. [DOI: 10.1007/s11255-020-02586-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/25/2020] [Indexed: 10/23/2022]
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Suresh H, Arun BS, Moger V, Vijayalaxmi PB, Murali Mohan KTK. A Prospective Study of Pulmonary Hypertension in Patients with Chronic Kidney Disease: A New and Pernicious Complication. Indian J Nephrol 2018; 28:127-134. [PMID: 29861563 PMCID: PMC5952451 DOI: 10.4103/ijn.ijn_36_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pulmonary hypertension (PH) is a recently recognized complication of chronic kidney disease (CKD), especially in end-stage renal disease. It has prevalence estimates of 30%-50% and is an independent predictor of increased mortality in CKD patients. The aim of this study is to analyze the prevalence of PH in patients with CKD, its severity in different stages of CKD, and risk factors for it. One hundred and eight patients with CKD treated at Karnataka Institute of Medical Sciences, Hubli, Karnataka, between January 1, 2014, and June 30, 2015, were selected. Clinical evaluation and relevant investigations including echocardiography were done. Follow-up echocardiography was done at 3 and 6 months and assessed. The mean age of studied population was 43.53 ± 14.63 years. Sex ratio was 2.72:1 (male:female). PH was present in 47 of 108 (43.5%) cases at beginning, 41 of 83 (491.4%) at 3 months, and 32 of 64 (50%) at 6 months. The prevalence and severity of PH increased with progression of CKD stage, although not statistically significant. Heart failure with reduced ejection fraction and heart failure with preserved EF were significantly higher among PH group compared to non-PH group (P < 0.01). Mean hemoglobin in PH group was significantly lower, compared to non-PH group (P < 0.01). Mean interdialytic weight gain and central venous pressure were higher among PH group than non-PH group. Higher calcium phosphate product ≥50 was more prevalent in PH group than in non-PH group. The majority of them had moderate PH at the beginning of the study which remained same, despite being on hemodialysis. PH is a common complication in CKD patients with prevalence of 43.5%-50%. Left-sided heart failure, anemia, fluid retention, and increased calcium phosphate product are the risk factors for developing PH.
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Affiliation(s)
- H Suresh
- Department of Cardiology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - B S Arun
- Department of General Medicine, MVJ Medical College, Bengaluru, Karnataka, India
| | - V Moger
- Department of Nephrology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - P B Vijayalaxmi
- Department of General Medicine, SDM Medical College, Dharwad, Karnataka, India
| | - K T K Murali Mohan
- Department of General Medicine, MVJ Medical College, Bengaluru, Karnataka, India
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Assessment of right ventricular dysfunction in end-stage renal disease patients on maintenance haemodialysis by cardiac magnetic resonance imaging. Eur J Radiol 2018; 102:89-94. [DOI: 10.1016/j.ejrad.2018.02.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 02/23/2018] [Accepted: 02/28/2018] [Indexed: 11/19/2022]
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8
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Shang W, Li Y, Ren Y, Li W, Wei H, Dong J. Prevalence of pulmonary hypertension in patients with chronic kidney disease without dialysis: a meta-analysis. Int Urol Nephrol 2018; 50:1497-1504. [PMID: 29582339 DOI: 10.1007/s11255-018-1853-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 03/21/2018] [Indexed: 01/11/2023]
Abstract
PURPOSE Recent epidemiological evidence attempts to demonstrate the risk of pulmonary hypertension (PH) among patients with chronic kidney disease (CKD) without dialysis, but prevalence estimates of PH in CKD without dialysis vary widely in the existing studies. This meta-analysis was to summarize the point prevalence of PH in adults with CKD without dialysis. METHODS PubMed, EMBASE, the Cochrane Collaboration, and the reference lists of relevant articles were searched to identify eligible studies. We used a random-effect meta-analysis model to estimate the prevalence of PH. Associations were tested in subgroups and meta-regression analyses. We also performed sensitivity analyses and assessments of publishing bias. RESULTS Twenty-one observational studies (n = 8012 participants) were included in this meta-analysis. The result of analysis in random-effect model showed that the pooled prevalence was 32% (95% CI 23-42%), with significant heterogeneity between these studies (I2 = 98%, P < 0.01). Stratified analyses found that the study design, region, sample size, year of publication, and definition of PH based on PASP ≥ 35 mmHg may explain the variation between studies. Sensitivity analysis further demonstrated the results to be robust. There was no evidence of publication bias. CONCLUSIONS PH is highly prevalent in patients with CKD without dialysis. Owing to the high heterogeneity, future well-designed and large prospective studies are encouraged to confirm the findings and definitively clarify the potential biological mechanisms.
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Affiliation(s)
- Weifeng Shang
- Department of Nephrology and Rheumatology, The Forth Hospital of Wuhan Affiliated with Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
| | - Yuanyuan Li
- Department of Respiratory Medicine, The Forth Hospital of Wuhan Affiliated with Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
| | - Yali Ren
- Department of Medical Affaires, Liyuan Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
| | - Wei Li
- Department of Nephrology and Rheumatology, The Forth Hospital of Wuhan Affiliated with Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
| | - HongLan Wei
- Department of Nephrology and Rheumatology, The Forth Hospital of Wuhan Affiliated with Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
| | - Junwu Dong
- Department of Nephrology and Rheumatology, The Forth Hospital of Wuhan Affiliated with Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China.
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Sun M, Cao X, Guo Y, Tan X, Dong L, Pan C, Shu X. Long-term impacts of hemodialysis on the right ventricle: Assessment via 3-dimensional speckle-tracking echocardiography. Clin Cardiol 2018; 41:87-95. [PMID: 29363796 DOI: 10.1002/clc.22857] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 11/06/2017] [Accepted: 11/21/2017] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Right ventricular (RV) dysfunction is a major cause of death in patients undergoing maintenance hemodialysis (MHD). We used 3-dimensional speckle-tracking echocardiography (3DSTE) to evaluate long-term impacts of MHD on RV function. HYPOTHESIS In this study, RV dysfunction in MHD patients will be revealed and studied in depth by 3DSTE. METHODS Echocardiography was performed on 110 consecutively enrolled individuals: 30 controls and 80 patients with MHD. Conventional echocardiographic parameters and 3DSTE parameters were obtained and compared between groups. Univariate and multivariate logistic regression analysis identified independent predictors of intradialytic hypotension (IDH). RESULTS Compared with the control group, RV end-diastolic volume (RVEDV) was markedly enlarged (46.1 ± 11.8 mL/m2 vs 42.3 ± 8.6 mL/m2 ; P = 0.047), whereas RV ejection fraction (RVEF) was significantly lower in the MHD group (50.6% ± 5.8% vs 55.2% ± 3.7%; P < 0.001). RV global, septal, and lateral wall longitudinal strains were also decreased in the MHD group (-18.2 ± 3.6 vs -22.6 ± 4.3%; -13.1 ± 3.8 vs -17.5 ± 5.5%; and -23.4 ± 4.7 vs -27.7 ± 4.0%, respectively; all P < 0.001). RVEF (odds ratio [OR]: 0.72, 95% confidence interval [CI]: 0.51 to 1.01, P = 0.038) and history of diabetes (OR: 11.14, 95% CI: 1.16 to 106.71, P = 0.036) were 2 independent predictors of IDH. Ultrafiltration rate was an independent factor associated with RVEF (β = -0.01, 95% CI: -0.019 to 0.001, P = 0.039). CONCLUSIONS RVEF by 3DSTE could be an important predictor of IDH in MHD patients, and lower ultrafiltration rate was protective for RVEF. 3DSTE may have potential in RV evaluation and risk stratification in MHD patients.
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Affiliation(s)
- Minmin Sun
- Department of Echocardiography, Zhongshan Hospital of Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Xuesen Cao
- Department of Nephrology, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Yao Guo
- Department of Echocardiography, Zhongshan Hospital of Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Xiao Tan
- Department of Nephrology, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Lili Dong
- Department of Echocardiography, Zhongshan Hospital of Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Cuizhen Pan
- Department of Echocardiography, Zhongshan Hospital of Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Xianhong Shu
- Department of Echocardiography, Zhongshan Hospital of Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Shanghai, China
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Najafian J, Taheri S, Mahaki B, Molavi S, Alami S, Khalesi S, Salehi A. Comparing right ventricular function and pulmonary artery pressure before and shortly after hemodialysis in patients with end-stage renal disease. Adv Biomed Res 2015; 4:197. [PMID: 26601085 PMCID: PMC4620613 DOI: 10.4103/2277-9175.166133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 06/27/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Early screening and diagnosis of right ventricular (RV) dysfunction and pulmonary artery hypertension is vital in patients with end-stage renal disease (ESRD) because of its relation to patients' survival. The present study is aimed to address and compare RV function parameters and pulmonary artery pressure (PAP) before and shortly after hemodialysis in patients with ESRD. MATERIALS AND METHODS This quasi-experimental study performed at Alzahra Hospital in Isfahan in 2014, 40 consecutive patients with ESRD that referred to hemodialysis ward were assessed by M-mode echocardiography and tissue Doppler imaging before and 30 min after completing hemodialysis to assess RV function parameters and PAP. RESULTS Following hemodialysis, mean body weight, both systolic, and diastolic blood pressures (BPs) and also mean systolic PAP significantly decreased, while tricuspid annulus plane systolic excursion (TAPSE), RV fractional area change (RVFAC) significantly increased 30 min after hemodialysis compared with before this procedure. However, systolic myocardial remained unchanged. Changes in body weight after dialysis was adversely associated with patients' age and duration of dialysis. Moreover, change in PAP was positively associated with the level of serum creatinine. CONCLUSION Early reduction in body weight and BP, as well as improvement in RV function, and PAP is predictable shortly after starting hemodialysis in patients with ESRD. We found that RVFAC and TAPSE values were dependent on preload, but RV S' velocity was load independent. Change in body weight is predicted more in older patients and those who undergoing prolonged hemodialysis. Change in PAP is strongly affected by the severity of renal failure, but RV function may not be influenced by age or duration of dialysis.
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Affiliation(s)
- Jamshid Najafian
- Isfahan Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan, Iran
| | - Shahram Taheri
- Department of Nephrology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Behzad Mahaki
- Department of Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Safieh Molavi
- Isfahan Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan, Iran
| | - Samaneh Alami
- Isfahan Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan, Iran
| | - Somayeh Khalesi
- Isfahan Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan, Iran
| | - Asma Salehi
- Isfahan Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan, Iran
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Evaluation of pulmonary artery pressure and resistance by pulsed Doppler echocardiography in patients with end-stage renal disease on dialysis therapy. J Saudi Heart Assoc 2015; 28:101-12. [PMID: 27053900 PMCID: PMC4803759 DOI: 10.1016/j.jsha.2015.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 09/03/2015] [Accepted: 09/16/2015] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Pulmonary hypertension (PH) is one of the most important comorbidities in patients undergoing hemodialysis (HD). The goal of the present work is to determine the possible etiologic factors for its occurrence. METHODS The prevalence of PH was estimated by Doppler echocardiography in a cohort of 100 patients aged 49.3 ± 13.9 years on regular HD. Mean pulmonary artery pressure was estimated from pulmonary acceleration time by Mahan's regression equation. Pulmonary vascular resistance and pulmonary capillary wedge pressure were calculated. We focused on the effect of HD on left and right ventricle diastolic and systolic function. Right ventricle systolic function was assessed by tricuspid annular systolic excursion and pulsed Doppler myocardial performance index. Since impaired endothelial function was postulated as an underlying cause of PH, we studied the effects of HD on brachial artery endothelial function. RESULTS The current study found that pulmonary hypertension was prevalent in 70% of patients on dialysis. Left atrium diameter, left ventricle mass indexed to body surface area, and mitral E/E' were increased in the dialysis group (4.4 ± 0.2 cm, 126.5 ± 24.6 g/m(2), and 16.9 ± 4.4, respectively, p < 0.001 for all). Pulmonary artery systolic pressure was positively correlated to duration of dialysis and negatively correlated to glomerular filtration rate (p < 0.001 and r = -0.991). Pulmonary vascular resistance was significantly increased in dialysis patients (1.9 ± 0.2 Wood units vs. 1.2 Wood units in controls, p < 0.001). Endothelial dysfunction, defined as brachial artery flow mediated dilatation <6%, was found in 46% of dialysis group. CONCLUSION Increased pulmonary artery systolic pressure in the HD population could be attributed to left atrium dilatation and left ventricle diastolic dysfunction. Pulmonary vascular resistance was significantly increased in dialysis group. This might be explained by impaired endothelial nitric oxide synthesis that not only caused systemic vasoconstriction but also affected the pulmonary vasculature.
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12
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Alkhouli M, Sandhu P, Boobes K, Hatahet K, Raza F, Boobes Y. Cardiac complications of arteriovenous fistulas in patients with end-stage renal disease. Nefrologia 2015; 35:234-45. [PMID: 26299166 DOI: 10.1016/j.nefro.2015.03.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 03/23/2015] [Indexed: 10/23/2022] Open
Abstract
Cardiovascular disease is the leading cause of the death in dialysis patients. Arteriovenous fistulas (AVFs) are associated with lower mortality and are viewed as the desired access option in most patients with advanced kidney disease needing dialysis. However, AVFs have significant and potentially deleterious effects on cardiac functions particularly in the setting of preexisting heart disease. This article provides a comprehensive and contemporary review to what is known about the impact of AVFs on: congestive heart failure, left ventricular hypertrophy, pulmonary hypertension, right ventricular dysfunction, coronary artery disease and valvular heart disease.
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Affiliation(s)
- Mohamad Alkhouli
- Cardiology Department, University of Rochester, Rochester, NY, USA.
| | - Paul Sandhu
- Department of Internal Medicine, Boston University, Boston, MA, USA
| | - Khlaed Boobes
- Department of Nephrology, Northwestern University, Chicago, IL, USA
| | - Kamel Hatahet
- Department of Nephrology, Temple University Hospital, Philadelphia, PA, USA
| | - Farhan Raza
- Cardiology Department, Temple University Hospital, Philadelphia, PA, USA
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13
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Weidemann F, Liu D, Niemann M, Herrmann S, Hu H, Gaudron P, Ertl G, Hu K. Abschätzung der linksventrikulären systolischen Funktion bei Patienten mit schlechter Bildqualität. Herz 2015; 40:240-9. [DOI: 10.1007/s00059-013-3924-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 07/10/2013] [Indexed: 11/28/2022]
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14
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Chiu DYY, Green D, Abidin N, Sinha S, Kalra PA. Echocardiography in hemodialysis patients: uses and challenges. Am J Kidney Dis 2014; 64:804-16. [PMID: 24751169 DOI: 10.1053/j.ajkd.2014.01.450] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 01/23/2014] [Indexed: 11/11/2022]
Abstract
Patients with end-stage renal disease undergoing hemodialysis have high rates of morbidity and mortality. Cardiovascular disease accounts for almost half of this mortality, with the single most common cause being sudden cardiac death. Early detection of abnormalities in cardiac structure and function may be important to allow timely and appropriate cardiac interventions. Echocardiography is noninvasive cardiac imaging that is widely available and provides invaluable information on cardiac morphology and function. However, it has limitations. Echocardiography is operator dependent, and image quality can vary depending on the operator's experience and the patient's acoustic window. Hemodialysis patients undergo regular hemodynamic changes that also may affect echocardiographic findings. An understanding of the prognostic significance and interpretation of echocardiographic results in this setting is important for patient care. There are some emerging techniques in echocardiographic imaging that can provide more detailed and accurate information compared with conventional 2-dimensional echocardiography. Use of these novel tools may further our understanding of the pathophysiology of cardiac disease in patients with end-stage renal disease undergoing hemodialysis.
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Affiliation(s)
- Diana Y Y Chiu
- Vascular Research Group, Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford; Institute of Population Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester
| | - Darren Green
- Vascular Research Group, Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford; Institute of Population Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester
| | - Nik Abidin
- Department of Cardiology, Salford Royal Hospital, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Smeeta Sinha
- Vascular Research Group, Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford; Institute of Population Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester
| | - Philip A Kalra
- Vascular Research Group, Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford; Institute of Population Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester.
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15
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Sise ME, Courtwright AM, Channick RN. Pulmonary hypertension in patients with chronic and end-stage kidney disease. Kidney Int 2013; 84:682-92. [PMID: 23739239 DOI: 10.1038/ki.2013.186] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 03/09/2013] [Accepted: 03/14/2013] [Indexed: 11/09/2022]
Abstract
Pulmonary hypertension is defined as a mean pulmonary artery pressure ≥25 mm Hg and is a recently recognized complication of chronic kidney disease and end-stage renal disease. There is significant epidemiological overlap with kidney disease and the underlying causes of World Health Organization group 1-4 pulmonary hypertension (pulmonary arteriopathy, left heart disease, chronic pulmonary disease, and chronic thromboembolic disease, respectively). In addition, an entity of 'unexplained pulmonary hypertension,' group 5, in patients with chronic kidney disease and end-stage renal disease has emerged, with prevalence estimates of 30-50%. The pathogenesis of pulmonary hypertension in this population is due to alterations in endothelial function, increased cardiac output, and myocardial dysfunction leading to elevated left heart filling pressure, with recent data suggesting that left heart dysfunction may account for the vast majority of pulmonary hypertension in patients with kidney disease. Pulmonary hypertension is an independent predictor of increased mortality in patients on dialysis and those undergoing kidney transplantation. This review summarizes what is known about the epidemiology, pathogenesis, transplantation outcomes, mortality, and treatment of pulmonary hypertension in patients with chronic kidney disease and end-stage renal disease.
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Affiliation(s)
- Meghan E Sise
- Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, New York, USA
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16
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Hu K, Liu D, Niemann M, Herrmann S, Gaudron PD, Ertl G, Weidemann F. Methods for Assessment of Left Ventricular Systolic Function in Technically Difficult Patients with Poor Imaging Quality. J Am Soc Echocardiogr 2013; 26:105-13. [DOI: 10.1016/j.echo.2012.11.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Indexed: 12/14/2022]
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