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Wang Y, Wang Y, Wu S, Xu N, Zhang Z, Ruan Z, Wang R, Geng X, Zhang C, Luan Z, Chen G, Ren H. Impact of volume indices in bioelectrical impedance measurement on the assessment of cardiac function indices by echocardiography in hemodialysis patients. Ren Fail 2024; 46:2375103. [PMID: 38973376 PMCID: PMC11232648 DOI: 10.1080/0886022x.2024.2375103] [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: 01/05/2024] [Accepted: 06/27/2024] [Indexed: 07/09/2024] Open
Abstract
INTRODUCTION Cardiovascular events resulting from volume overload are a primary cause of mortality in hemodialysis patients. Bioelectrical impedance analysis (BIA) is significantly valuable for assessing the volume status of hemodialysis (HD) patients. In this article, we explore the correlation between the volume index measured by BIA and the cardiac function index assessed by echocardiography (ECG) in HD patients. METHODS Between April and November 2018, we conducted a cross-sectional study involving randomly selected 126 maintenance HD patients. Comprehensive data on medical history and laboratory test results were collected. Subsequently, we investigated the correlation between volume indices measured by BIA and cardiac function parameters by ECG. RESULTS We discovered a significant correlation between the volume indices measured by BIA and various parameter of cardiac function. The Left Ventricular Hypertrophy (LVH) group exhibited higher levels of the percentage of Extracellular Water (ECW%) and the percentage of Total Body Water (TBW%) compared to the Non-LVH group. Extracellular Water (ECW) and Third Interstitial Fluid Volume (TSFV) were identified as independent risk factors for Left Ventricular Mass (LVM), and both demonstrated a high predictive value for LVM. ECW% emerged as an independent risk factor for the Left Ventricular Mass Index (LVMI), with a high predictive value for LVMI. CONCLUSION ECW and TSFV were found to be positively associated with cardiac function parameters in HD patients.
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Affiliation(s)
- Yudan Wang
- Department of Nephrology, The Affiliated Huaihai Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yang Wang
- Department of Nephrology, The Affiliated Huaihai Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Shun Wu
- Department of Nephrology, The Affiliated Huaihai Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Na Xu
- Department of Nephrology, The Affiliated Huaihai Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Zhaoyong Zhang
- Department of Nephrology, The Affiliated Huaihai Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Zhenmin Ruan
- Department of Nephrology, The Affiliated Huaihai Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Rui Wang
- Department of Nephrology, The Affiliated Huaihai Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xin Geng
- Department of Nephrology, The Affiliated Huaihai Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Chuanzhen Zhang
- Department of Nephrology, The Affiliated Huaihai Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Zhiyong Luan
- Department of Ultrasound, The Affiliated Huaihai Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Guofang Chen
- Department of Neurology, The Affiliated Xuzhou Central Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Hongqi Ren
- Department of Nephrology, The Affiliated Huaihai Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
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Elsayed E, Farag YM, Ravi KS, Chertow GM, Mc Causland FR. Association of Changes in Vector Length with Changes in Left Ventricular Mass among Patients on Maintenance Hemodialysis: A Secondary Analysis of the Frequent Hemodialysis Network Daily Trial. KIDNEY360 2024; 5:870-876. [PMID: 38656312 PMCID: PMC11219120 DOI: 10.34067/kid.0000000000000443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/09/2024] [Indexed: 04/26/2024]
Abstract
Key Points Bioimpedance has been proposed as an objective method to assess volume status among patients receiving maintenance hemodialysis. The Frequent Hemodialysis Network Daily Trial measured bioimpedance parameters of volume status (vector length) and cardiac magnetic resonance imaging at baseline and 12 months. We observed that changes in vector length were inversely associated with changes in left ventricular mass and volume over a 12-month period. Background Hypervolemia is thought to be a major contributor to higher left ventricular mass (LVM), a potent predictor for cardiovascular mortality among patients on maintenance hemodialysis. We hypothesized that a decrease in vector length (a bioimpedance proxy of hypervolemia) would be associated with an increase in LVM. Methods Using data from the Frequent Hemodialysis Network Daily Trial (n =160), we used linear regression to assess the association of changes in vector length from baseline to month 12 with changes in magnetic resonance imaging measures of LVM and other cardiac parameters. We adjusted models for the randomized group, baseline vector length, age, sex, race, body mass index, vascular access, dialysis vintage, history of hypertension, heart failure, and diabetes, residual kidney function, predialysis systolic BP, ultrafiltration rate, serum-dialysate sodium gradient, hemoglobin, phosphate, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use, erythropoietin dose, and equilibrated Kt/V. Results The mean age of the patients was 50±13 years; 35% were female. In the fully adjusted models, a decline in vector length (per 50 Ω/m; i.e ., increase in volume) was associated with a 6.8 g (95% confidence interval [CI], −0.1 to 13.7) and 2.6 g/m2 (95% CI, −1.2 to 6.3) increase in LVM and LVM index, respectively, and an increase of 15.0 ml (95% CI, 7.5 to 22.4), 7.3 ml (95% CI, 3.0 to 12.7), 7.8 ml (95% CI, 3.0 to 12.7), and −0.9% (95% CI, −3.1 to 1.3) in left ventricular end-diastolic volume, left ventricular end-systolic volume, left ventricular stroke volume, and left ventricular ejection fraction, respectively. The lowest tertile of change in vector length (i.e ., greater increase in volume) was associated with greater increases in left ventricular end-diastolic volume and left ventricular stroke volume, versus the highest tertile. There was no evidence of heterogeneity by randomized group. Conclusions Change in vector length, a bioimpedance-derived proxy of volume status, was inversely associated with indices of LVM and volume measured by cardiac magnetic resonance imaging in patients randomized to conventional or frequent hemodialysis over 12 months.
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Affiliation(s)
- Enass Elsayed
- Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Youssef M.K. Farag
- Bayer US, LLC, Pittsburgh, Pennsylvania
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Katherine Scovner Ravi
- Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Glenn M. Chertow
- Departments of Medicine, Epidemiology and Population Health, and Health Policy, Stanford University School of Medicine, Stanford, California
| | - Finnian R. Mc Causland
- Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Anastasiou V, Theodorakopoulou MP, Kamperidis V, Daios S, Tsilonis K, Alexandrou ME, Moysidis DV, Boutou A, Giannakoulas G, Ziakas A, Sarafidis P. Changes in right ventricular dimensions, function, and pulmonary circulation loading according to the degree of interdialytic weight gain in maintenance hemodialysis patients. Ther Apher Dial 2024. [PMID: 38690674 DOI: 10.1111/1744-9987.14135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/23/2024] [Accepted: 04/22/2024] [Indexed: 05/02/2024]
Abstract
INTRODUCTION The aim of this study was to investigate changes in echocardiographic right ventricular (RV) indices in relation to the degree of fluid accumulation between hemodialysis sessions, evaluated according to the recommended threshold of interdialytic-weight-gain corrected for dry weight (IDWG%). METHODS A post-hoc analysis was performed using data from 41 maintenance hemodialysis patients. Patients were divided into a higher (>4.5%) and a lower (<4.5%) IDWG% group and underwent an echocardiographic assessment at the start and the end of the 3-day and the 2-day interdialytic interval. RESULTS RV systolic pressure (RVSP) increments were more pronounced in the higher compared to the lower IDWG% group (16.43 ± 5.37 vs. 14.11 ± 13.38 mm Hg respectively, p = 0.015) over the 3-day interval, while changes in RV filling pressures, did not differ significantly between the groups (p = 0.84). CONCLUSIONS During the 3-day interdialytic interval, pulmonary circulation is particularly overloaded in patients with fluid accumulation higher than the recommended thresholds, as evidenced by higher RVSP elevations.
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Affiliation(s)
- Vasileios Anastasiou
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Marieta P Theodorakopoulou
- First Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasileios Kamperidis
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stylianos Daios
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Tsilonis
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria-Eleni Alexandrou
- First Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios V Moysidis
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Afroditi Boutou
- Department of Respiratory Medicine, Hippokration Hospital, Thessaloniki, Greece
| | - George Giannakoulas
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonios Ziakas
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pantelis Sarafidis
- First Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Ladányi Z, Bárczi A, Fábián A, Ujvári A, Cseprekál O, Kis É, Reusz GS, Kovács A, Merkely B, Lakatos BK. Get to the heart of pediatric kidney transplant recipients: Evaluation of left- and right ventricular mechanics by three-dimensional echocardiography. Front Cardiovasc Med 2023; 10:1094765. [PMID: 37008334 PMCID: PMC10063872 DOI: 10.3389/fcvm.2023.1094765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/15/2023] [Indexed: 03/19/2023] Open
Abstract
BackgroundKidney transplantation (KTX) markedly improves prognosis in pediatric patients with end-stage kidney failure. Still, these patients have an increased risk of developing cardiovascular disease due to multiple risk factors. Three-dimensional (3D) echocardiography allows detailed assessment of the heart and may unveil distinct functional and morphological changes in this patient population that would be undetectable by conventional methods. Accordingly, our aim was to examine left- (LV) and right ventricular (RV) morphology and mechanics in pediatric KTX patients using 3D echocardiography.Materials and methodsPediatric KTX recipients (n = 74) with median age 20 (14–26) years at study enrollment (43% female), were compared to 74 age and gender-matched controls. Detailed patient history was obtained. After conventional echocardiographic protocol, 3D loops were acquired and measured using commercially available software and the ReVISION Method. We measured LV and RV end-diastolic volumes indexed to body surface area (EDVi), ejection fraction (EF), and 3D LV and RV global longitudinal (GLS) and circumferential strains (GCS).ResultsBoth LVEDVi (67 ± 17 vs. 61 ± 9 ml/m2; p < 0.01) and RVEDVi (68 ± 18 vs. 61 ± 11 ml/m2; p < 0.01) were significantly higher in KTX patients. LVEF was comparable between the two groups (60 ± 6 vs. 61 ± 4%; p = NS), however, LVGLS was significantly lower (−20.5 ± 3.0 vs. −22.0 ± 1.7%; p < 0.001), while LVGCS did not differ (−29.7 ± 4.3 vs. −28.6 ± 10.0%; p = NS). RVEF (59 ± 6 vs. 61 ± 4%; p < 0.05) and RVGLS (−22.8 ± 3.7 vs. −24.1 ± 3.3%; p < 0.05) were significantly lower, however, RVGCS was comparable between the two groups (−23.7 ± 4.5 vs. −24.8 ± 4.4%; p = NS). In patients requiring dialysis prior to KTX (n = 64, 86%) RVGCS showed correlation with the length of dialysis (r = 0.32, p < 0.05).ConclusionPediatric KTX patients demonstrate changes in both LV and RV morphology and mechanics. Moreover, the length of dialysis correlated with the contraction pattern of the right ventricle.
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Affiliation(s)
- Zsuzsanna Ladányi
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Correspondence: Zsuzsanna Ladányi
| | - Adrienn Bárczi
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Alexandra Fábián
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Adrienn Ujvári
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Orsolya Cseprekál
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Éva Kis
- Department of Pediatric Cardiology, Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary
| | | | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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Paglialonga F, Consolo S, Edefonti A, Montini G. The first hour refill index: a promising marker of volume overload in children and young adults on chronic hemodialysis. Pediatr Nephrol 2018; 33:1209-1214. [PMID: 29492673 DOI: 10.1007/s00467-018-3915-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 01/18/2018] [Accepted: 02/01/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Volume overload is a known risk factor for cardiovascular complications in children on hemodialysis (HD), but a measurable index of volume overload is still lacking. METHODS We propose a novel index of pre-HD volume overload based on blood volume (BV) monitoring, the first hour refill index (RI), calculated as the ratio between the ultrafiltration rate indexed for body weight during the first HD hour and the percent BV change at the first hour of the treatment. This parameter was retrospectively calculated in 121 sessions in 11 oligoanuric children and young adults on chronic HD, with median age 14.3 years (range 5.4-22.4), and its association with left-ventricular mass index, pre-HD blood pressure, and number of antihypertensive medications was evaluated. RESULTS The median RI was 2.07 ml/kg/h/%. There was a significant correlation between RI and median LVMI (r 0.66, p = 0.028), which was 53.4 g/m2.7 (45.7-64) in patients with a median RI > 2, and 36.6 g/m2.7 (24.9-47) in those with a median RI < 2 ml/kg/h/% (p = 0.01). The number of antihypertensive drugs per patient was significantly higher in patients with a RI > 2 than in those with a RI < 2 ml/kg/h/% (three vs one per patient; p = 0.02) while blood pressure was not significantly different between the two groups. CONCLUSIONS The ratio between the ultrafiltration rate per body weight and the BV change during the first hour of a HD session could be a promising index of refill capacity and pre-HD volume overload in children and young adults on chronic HD.
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Affiliation(s)
- Fabio Paglialonga
- Pediatric Nephrology, Dialysis, and Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy.
| | - Silvia Consolo
- Pediatric Nephrology, Dialysis, and Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
| | - Alberto Edefonti
- Pediatric Nephrology, Dialysis, and Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis, and Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Nubé MJ, Hoekstra T, Doganer V, Bots ML, Blankestijn PJ, van den Dorpel M, Kamp O, Ter Wee PM, de Roij van Zuijdewijn CLM, Grooteman MPC. Left ventricular geometric patterns in end-stage kidney disease: Determinants and course over time. Hemodial Int 2018; 22:359-368. [DOI: 10.1111/hdi.12644] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 01/06/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Menso J. Nubé
- Department of Nephrology; Amsterdam Cardiovascular Sciences, VU University Medical Center; Amsterdam the Netherlands
| | - Tiny Hoekstra
- Department of Nephrology; Amsterdam Cardiovascular Sciences, VU University Medical Center; Amsterdam the Netherlands
| | - Volkan Doganer
- Department of Nephrology; Amsterdam Cardiovascular Sciences, VU University Medical Center; Amsterdam the Netherlands
| | - Michiel L. Bots
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; Utrecht the Netherlands
| | - Peter J. Blankestijn
- Department of Nephrology; University Medical Center Utrecht; Utrecht the Netherlands
| | | | - Otto Kamp
- Department of Cardiology; Amsterdam Cardiovascular Sciences, VU University Medical Center; Amsterdam the Netherlands
| | - Piet M. Ter Wee
- Department of Nephrology; Amsterdam Cardiovascular Sciences, VU University Medical Center; Amsterdam the Netherlands
| | | | - Muriel P. C. Grooteman
- Department of Nephrology; Amsterdam Cardiovascular Sciences, VU University Medical Center; Amsterdam the Netherlands
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Wang W, Feng SJ, Li H, Zhang XD, Wang SX. Correlation of Lower Concentrations of Hydrogen Sulfide with Activation of Protein Kinase CβII in Uremic Accelerated Atherosclerosis Patients. Chin Med J (Engl) 2016; 128:1465-70. [PMID: 26021502 PMCID: PMC4733763 DOI: 10.4103/0366-6999.157653] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Hydrogen sulfide (H2S) plays a protective role in chronic hemodialysis (CHD) patients. In this study, we further investigate the relationship between H2S and conventional protein kinase CβII (cPKCβII) in CHD patients with uremic accelerated atherosclerosis (UAAS). Methods: A total of 30 healthy people, 30 CHD patients without AS and 30 CHD patients with AS (CHD + AS) were studied. Plasma H2S was measured with a sulfide sensitive electrode, and cPKCβII membrane translocation was detected by Western blotting. Results: Plasma H2S in CHD + AS group was significantly lower than that in CHD patients. cPKCβII membrane translocation in CHD + AS group increased significantly compared with CHD group. Plasma H2S concentration was negatively correlated with cPKCβII membrane translocation in CHD + AS patients. Conclusions: These findings suggest a possible linkage between H2S metabolism and cPKCβII activation, which may contribute to the development of UAAS in CHD patients.
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Affiliation(s)
| | | | - Han Li
- Institute of Uro-Nephrology, Beijing Chao-Yang Hospital, Capital Medical University; Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University, Nephrology Faculty, Capital Medical University, Beijng 100020, China
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Topbaş E, Kavalalı T, Öztürk F, Can S, Dedekoç Ş, Sapcı Y. THE IMPACT OF CONTROLLED FLUID AND SALT INTAKE TRAINING IN PATIENTS UNDERGOING HAEMODIALYSIS. J Ren Care 2015; 41:247-52. [PMID: 26119772 DOI: 10.1111/jorc.12133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Serious complications can occur when patients have difficulty in adhering to fluid and salt recommendations. OBJECTIVES AND DESIGN This study was designed as an experimental study with the aims of evaluating the effects of controlled fluid and salt intake training on the intra-dialytic process and on the level of patients' knowledge. The factors that had an impact on the training process were also evaluated. The effectiveness of the planned training was evaluated at 0, 1, 3 and 6 months. RESULTS There were no significant differences in salt intake exceeding 3 g per day (p > 0.05) between the preliminary and final test, although a statistically significant change was observed at months 1 and 3. The effectiveness of the training decreased by the end of the 3rd month. A statistically significant change was obtained prior to and after the training at months 0, 1, 3 and 6 with respect to the rates of daily fluid intake exceeding 1,500 ml, hypovolaemia, hypervolaemia, awareness of salt-rich food and correct calculation of daily fluid intake by the patients. Also a significant reduction was observed in the volume of oedema after the training. The patients' age, gender, marital status and educational background did not have a significant effect on daily salt intake of more than 3 g, daily fluid intake of more than 1,500 ml, and level of knowledge regarding fluid and salt control. CONCLUSIONS The training was effective at some time points in decreasing salt and fluid intake. This training should be repeated at certain intervals for the behavioural changes to become permanent.
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Affiliation(s)
- Eylem Topbaş
- Amasya University, School of Health, Nursing Department, Amasya, Turkey
| | - Tuğba Kavalalı
- Amasya University, School of Health, Nursing Department, Amasya, Turkey
| | - Feyza Öztürk
- Amasya University, School of Health, Nursing Department, Amasya, Turkey
| | - Semih Can
- Amasya University, School of Health, Nursing Department, Amasya, Turkey
| | - Şule Dedekoç
- Amasya University, School of Health, Nursing Department, Amasya, Turkey
| | - Yasemin Sapcı
- Amasya University, School of Health, Nursing Department, Amasya, Turkey
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Paglialonga F, Consolo S, Galli MA, Testa S, Edefonti A. Interdialytic weight gain in oligoanuric children and adolescents on chronic hemodialysis. Pediatr Nephrol 2015; 30:999-1005. [PMID: 25395362 DOI: 10.1007/s00467-014-3005-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 10/24/2014] [Accepted: 10/28/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Little is known about the clinical impact of interdialytic weight gain (IDWG) on oligoanuric children undergoing chronic hemodialysis (HD). METHODS We retrospectively assessed IDWG, left ventricular mass index (LVMI) and its changes (ΔLVMI), pre-HD systolic and diastolic blood pressure (DBP), residual urine output, Kt/V, the frequency of intradialytic symptoms, normalized protein catabolic rate, and the 3-month change in the dry weight of 16 hemodialyzed oligoanuric patients with a median age of 14.8 years (range 5.0-17.9). RESULTS There was a significant correlation between IDWG and median LVMI (r 0.55, p = 0.026), which was 27.3 g/m(2.7) (22.5-37.6) in the patients with a median IDWG of <4 %, and 44.3 g/m(2.7) (28.2-68.7) in those with a median IDWG of >4 % (p = 0.003). None of the four patients with an IDWG of <4 % showed left ventricular hypertrophy, compared with 10 of the 12 patients (83.3 %) with an IDWG of >4 % (p = 0.003); the former also had a better median ΔLVMI (-33.5 % vs -13.0 %; p = 0.02) and a lower median DBP sds (0.24 vs 1.72, p = 0.04). CONCLUSIONS There is a significant correlation between IDWG and LVMI in pediatric oligoanuric patients on chronic HD: those with an IDWG of >4 % are at a higher risk of left ventricular hypertrophy.
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Affiliation(s)
- Fabio Paglialonga
- Pediatric Nephrology and Dialysis Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy,
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Li H, Feng SJ, Su LL, Wang W, Zhang XD, Wang SX. Serum hepcidin predicts uremic accelerated atherosclerosis in chronic hemodialysis patients with diabetic nephropathy. Chin Med J (Engl) 2015; 128:1351-7. [PMID: 25963357 PMCID: PMC4830316 DOI: 10.4103/0366-6999.156781] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Hepcidin, as a regulator of body iron stores, has been recently discovered to play a critical role in the pathogenesis of anemia of chronic disease. Atherosclerotic cardiovascular disease is the most common complication and the leading cause of death in chronic hemodialysis (CHD) patients. In the current study, we aimed to explore the relationship between serum hepcidin and uremic accelerated atherosclerosis (UAAS) in CHD patients with diabetic nephropathy (CHD/DN). METHODS A total of 78 CHD/DN and 86 chronic hemodialyzed nondiabetic patients with chronic glomerulonephritis (CHD/non-DN) were recruited in this study. The level of serum hepcidin-25 was specifically measured by liquid chromatography-tandem mass spectrometry. Serum levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were measured by enzyme-linked immunosorbent assay. RESULTS High serum level of hepcidin-25 was seen in CHD patients. Serum hepcidin-25 in CHD/DN was significantly higher than that in CHD/non-DN patients. Serum hepcidin-25 was positively correlated with ferritin, high-sensitivity C-reactive protein (hs-CRP), TNF-α, and IL-6 in CHD/DN patients. CHD/DN patients exhibited higher common carotid artery intima media thickness (CCA-IMT), hs-CRP, and hepcidin-25 levels than that in CHD/non-DN patients. Moreover, in CHD/DN patients, CCA-IMT was positively correlated with serum hepcidin, hs-CRP, and low-density lipoprotein-cholesterol. On multiple regression analysis, serum hepcidin and hs-CRP level exhibited independent association with IMT in CHD/DN patients. CONCLUSIONS These findings suggest possible linkage between iron metabolism and hepcidin modulation abnormalities that may contribute to the development of UAAS in CHD/DN patients.
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Affiliation(s)
- Han Li
- Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University; Nephrology Faculty, Capital Medical University, Beijng 100020, China
- Institute of Uro-Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijng 100020, China
| | - Su-Juan Feng
- Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University; Nephrology Faculty, Capital Medical University, Beijng 100020, China
- Institute of Uro-Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijng 100020, China
| | - Lu-Lu Su
- Institute of Uro-Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijng 100020, China
| | - Wei Wang
- Institute of Uro-Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijng 100020, China
| | - Xiao-Dong Zhang
- Institute of Uro-Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijng 100020, China
| | - Shi-Xiang Wang
- Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University; Nephrology Faculty, Capital Medical University, Beijng 100020, China
- Institute of Uro-Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijng 100020, China
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Haskin O, Wong CJ, McCabe L, Begin B, Sutherland SM, Chaudhuri A. 44-h ambulatory blood pressure monitoring: revealing the true burden of hypertension in pediatric hemodialysis patients. Pediatr Nephrol 2015; 30:653-60. [PMID: 25266709 DOI: 10.1007/s00467-014-2964-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 09/09/2014] [Accepted: 09/10/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND The blood pressure (BP) burden is high in pediatric hemodialysis (HD) patients and adversely affects prognosis. The aim of this study was to examine whether 44-h ambulatory BP monitoring (ABPM) provides additional relevant BP data compared with 24-h ABPM. METHODS ABPM was initiated at the end of the mid-week dialysis run in 13 stable pediatric HD patients and continued until the next run for 44 h. Day 1 was defined as the initial 24-h ABPM and Day 2 as the time period after that until the next dialysis run. All patients had an echocardiogram to calculate the left ventricular mass index (LVMI). RESULTS A higher percentage of patients were diagnosed with hypertension from the 44-h ABPM than from the 24-h ABPM. All BP indexes and loads (except nighttime diastolic load) were significantly higher on Day 2 than on Day 1. Patients with BP loads of ≥ 25 % on 44-h ABPM had significantly higher LVMI than those patients with normal BP loads. No such association was found with 24-h ABPM and LVMI. Higher interdialytic weight gain was associated with higher Day-2 nighttime systolic BP load. CONCLUSIONS The 44-h ABPM provides more information than the 24-h ABPM in terms of diagnosing and assessing the true burden of hypertension in pediatric HD patients. Elevated BP loads from 44-h ABPM correlate with a higher LVMI on the echocardiogram.
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Affiliation(s)
- Orly Haskin
- Division of Nephrology, Department of Pediatrics, Stanford University, 300 Pasteur Drive, Room G306, Stanford, CA, 94305-5208, USA
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12
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Merchant A, Wald R, Goldstein MB, Yuen D, Kirpalani A, Dacouris N, Ray JG, Kiaii M, Leipsic J, Kotha V, Deva D, Yan AT. Relationship between different blood pressure measurements and left ventricular mass by cardiac magnetic resonance imaging in end-stage renal disease. ACTA ACUST UNITED AC 2015; 9:275-84. [PMID: 25753299 DOI: 10.1016/j.jash.2015.01.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 12/21/2014] [Accepted: 01/19/2015] [Indexed: 10/24/2022]
Abstract
Hypertension is prevalent in patients with end-stage renal disease and is strongly associated with left ventricular hypertrophy (LVH), an independent predictor of cardiovascular mortality. Blood pressure (BP) monitoring in hemodialysis patients may be unreliable because of its lability and variability. We compared different methods of BP measurement and their relationship with LVH on cardiac magnetic resonance imaging. Sixty patients undergoing chronic hemodialysis at a single dialysis center had BP recorded at each dialysis session over 12 weeks: pre-dialysis, initial dialysis, nadir during dialysis, and post-dialysis. Forty-five of these patients also underwent 44-hour inter-dialytic ambulatory BP monitoring. Left ventricular mass index (LVMI) was measured using cardiac magnetic resonance imaging and the presence of LVH was ascertained. Receiver operator characteristic curves were generated for each BP measurement for predicting LVH. The mean LVMI was 68 g/m(2) (SD = 15 g/m(2)); 13/60 patients (22%) had LVH. Mean arterial pressure measured shortly after initiation of dialysis session was most strongly correlated with LVMI (Pearson correlation coefficient r = 0.59, P < .0001). LVH was best predicted by post-dialysis systolic BP (area under the curve, 0.83; 95% confidence interval, 0.72-0.94) and initial dialysis systolic BP (area under the curve, 0.81; 95% confidence interval, 0.70-0.92). Forty-four-hour ambulatory BP and BP variability did not significantly predict LVH. Initial dialysis mean arterial pressure and systolic BP and post-dialysis systolic BP are the strongest predictors of LVH, and may represent the potentially best treatment targets in hemodialysis patients to prevent end-organ damage. Further studies are needed to confirm whether treatment targeting these BP measurements can optimize cardiovascular outcomes.
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Affiliation(s)
- Asad Merchant
- University of Toronto, Toronto, ON, Canada; Division of Nephrology, St. Michael's Hospital, Toronto, ON, Canada
| | - Ron Wald
- University of Toronto, Toronto, ON, Canada; Division of Nephrology, St. Michael's Hospital, Toronto, ON, Canada; Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
| | - Marc B Goldstein
- Division of Nephrology, St. Michael's Hospital, Toronto, ON, Canada; Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Darren Yuen
- Division of Nephrology, St. Michael's Hospital, Toronto, ON, Canada; Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Anish Kirpalani
- University of Toronto, Toronto, ON, Canada; Department of Medical Imaging, St. Michael's Hospital, Toronto, ON, Canada
| | - Niki Dacouris
- Division of Nephrology, St. Michael's Hospital, Toronto, ON, Canada
| | - Joel G Ray
- University of Toronto, Toronto, ON, Canada; Department of Obstetrics and Gynecology, and Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, ON, Canada
| | - Mercedeh Kiaii
- Division of Nephrology, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Jonathan Leipsic
- Department of Radiology and Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Vamshi Kotha
- University of Toronto, Toronto, ON, Canada; Department of Medical Imaging, St. Michael's Hospital, Toronto, ON, Canada
| | - Djeven Deva
- University of Toronto, Toronto, ON, Canada; Department of Medical Imaging, St. Michael's Hospital, Toronto, ON, Canada
| | - Andrew T Yan
- University of Toronto, Toronto, ON, Canada; Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Terrence Donnelly Heart Centre, St. Michael's Hospital, Toronto, ON, Canada.
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13
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Li H, Feng SJ, Zhang GZ, Wang SX. Correlation of lower concentrations of hydrogen sulfide with atherosclerosis in chronic hemodialysis patients with diabetic nephropathy. Blood Purif 2014; 38:188-94. [PMID: 25531647 DOI: 10.1159/000368883] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 10/03/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS To explore the relationship between hydrogen sulfide (H2S) and uremic accelerated atherosclerosis (UAAS) in chronic hemodialysis patients with diabetic nephropathy (CHD/DN). METHODS A total of 36 CHD/DN and 32 chronic hemodialyzed non-diabetic patients with chronic glomerulonephritis (CHD/non-DN) were studied. Plasma H2S was measured with a sulfide sensitive electrode. RESULTS Plasma H2S in CHD/DN was significantly lower than that in CHD/non-DN patients. Plasma H2S was positively correlated with plasma TGF-β1, and negatively correlated with MMP-12 in CHD/DN patients. CHD/DN patients exhibited higher CCA-IMT, hsCRP, and lower H2S levels than in CHD/non-DN patients. Moreover, in CHD/DN patients, CCA-IMT was negatively correlated with plasma H2S, and positively correlated with hsCRP and LDL. On multiple regression analysis, H2S levels exhibited independent association with IMT in CHD/DN patients. CONCLUSIONS These findings suggest possible linkage between H2S metabolism and TGF-β/Smad signaling pathway modulation abnormalities that may contribute to the development of UAAS in CHD/DN patients.
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Affiliation(s)
- Han Li
- Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University, Nephrology Faculty, Capital Medical University, Beijing, China
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14
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Dunlop JL, Vandal AC, de Zoysa JR, Gabriel RS, Haloob IA, Hood CJ, Matheson PJ, McGregor DOR, Rabindranath KS, Semple DJ, Marshall MR. Rationale and design of the Sodium Lowering In Dialysate (SoLID) trial: a randomised controlled trial of low versus standard dialysate sodium concentration during hemodialysis for regression of left ventricular mass. BMC Nephrol 2013; 14:149. [PMID: 23855560 PMCID: PMC3720185 DOI: 10.1186/1471-2369-14-149] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 07/08/2013] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The current literature recognises that left ventricular hypertrophy makes a key contribution to the high rate of premature cardiovascular mortality in dialysis patients. Determining how we might intervene to ameliorate left ventricular hypertrophy in dialysis populations has become a research priority. Reducing sodium exposure through lower dialysate sodium may be a promising intervention in this regard. However there is clinical equipoise around this intervention because the benefit has not yet been demonstrated in a robust prospective clinical trial, and several observational studies have suggested sodium lowering interventions may be deleterious in some dialysis patients. METHODS/DESIGN The Sodium Lowering in Dialysate (SoLID) study is funded by the Health Research Council of New Zealand. It is a multi-centre, prospective, randomised, single-blind (outcomes assessor), controlled parallel assignment 3-year clinical trial. The SoLID study is designed to study what impact low dialysate sodium has upon cardiovascular risk in dialysis patients. The study intends to enrol 118 home hemodialysis patients from 6 sites in New Zealand over 24 months and follow up each participant over 12 months. Key exclusion criteria are: patients who dialyse more frequently than 3.5 times per week, pre-dialysis serum sodium of <135 mM, and maintenance hemodiafiltration. In addition, some medical conditions, treatments or participation in other dialysis trials, which contraindicate the SoLID study intervention or confound its effects, will be exclusion criteria. The intervention and control groups will be dialysed using dialysate sodium 135 mM and 140 mM respectively, for 12 months. The primary outcome measure is left ventricular mass index, as measured by cardiac magnetic resonance imaging, after 12 months of intervention. Eleven or more secondary outcomes will be studied in an attempt to better understand the physiologic and clinical mechanisms by which lower dialysate sodium alters the primary end point. DISCUSSION The SoLID study is designed to clarify the effect of low dialysate sodium upon the cardiovascular outcomes of dialysis patients. The study results will provide much needed information about the efficacy of a cost effective, economically sustainable solution to a condition which is curtailing the lives of so many dialysis patients. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry number: ACTRN12611000975998.
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Affiliation(s)
- Joanna Leigh Dunlop
- South Auckland Clinical School, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 93311, Otahuhu, Auckland 1640, New Zealand
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15
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Paglialonga F, Ardissino G, Galli MA, Scarfia RV, Testa S, Edefonti A. Bioimpedance analysis and cardiovascular status in pediatric patients on chronic hemodialysis. Hemodial Int 2013; 16 Suppl 1:S20-5. [PMID: 23036032 DOI: 10.1111/j.1542-4758.2012.00743.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Bioimpedance analysis (BIA) is reported to be useful in assessing dry weight (DW) in patients on hemodialysis (HD), but its exact role has never been clearly defined. We reviewed our experience of using the BIA measure of reactance (Xc) in pediatric patients on chronic HD. Our approach is currently based on identifying a range of patient-specific Xc values at which a child can be considered at DW according to a multidisciplinary assessment. Values lower than the patient-specific limit suggests the need for a reduction in DW, whereas values higher than the limit suggest that DW should be increased. The accuracy of our approach was retrospectively assessed by analyzing the left ventricular mass index (LVMI) and the incidence of pulmonary edema (PE) in two groups: The first consisted of 13 patients (median age 15.6 years) on dialysis in 2007, before the introduction of the BIA-based approach; the second included 18 patients (median 14.8 years) on dialysis in 2011. In 2007, three children experienced four episodes of PE, whereas no PE occurred in 2011. The median LVMI was 56.8 g/m(2.7) in 2007, and 44.5 g/m(2.7) in 2011 (P < 0.05). The percentage of patients with LV hypertrophy (LVMI>38.5 g/m(2.7)) was 92.3% in 2007 and 61.1% in 2011 (P < 0.05). There were no between-group differences in terms of blood pressure, antihypertensive medications, percentage of symptomatic sessions, or biochemistry. In conclusion, a simple approach based on BIA may be useful in assessing DW in pediatric patients on HD, and thus improve their cardiovascular status.
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Affiliation(s)
- Fabio Paglialonga
- Pediatric Nephrology and Dialysis Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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Franczyk-Skóra B, Gluba A, Banach M, Kozłowski D, Małyszko J, Rysz J. Prevention of sudden cardiac death in patients with chronic kidney disease. BMC Nephrol 2012. [PMID: 23206758 PMCID: PMC3519551 DOI: 10.1186/1471-2369-13-162] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Cardiovascular deaths account for about 40% of all deaths of patients with chronic kidney disease (CKD), particularly those on dialysis, while sudden cardiac death (SCD) might be responsible for as many as 60% of SCD in patients undergoing dialysis. Studies have demonstrated a number of factors occurring in hemodialysis (HD) that could lead to cardiac arrhythmias. Patients with CKD undergoing HD are at high risk of ventricular arrhythmia and SCD since changes associated with renal failure and hemodialysis-related disorders overlap. Antiarrhythmic therapy is much more difficult in patients with CKD, but the general principles are similar to those in patients with normal renal function - at first, the cause of arrhythmias should be found and eliminated. Also the choice of therapy is narrowed due to the altered pharmacokinetics of many drugs resulting from renal failure, neurotoxicity of certain drugs and their complex interactions. Cardiac pacing in elderly patients is a common method of treatment. Assessment of patients’ prognosis is important when deciding whether to implant complex devices. There are reports concerning greater risk of surgical complications, which depends also on the extent of the surgical site. The decision concerning implantation of a pacing system in patients with CKD should be made on the basis of individual assessment of the patient.
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Affiliation(s)
- Beata Franczyk-Skóra
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Lodz, Poland
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Current World Literature. Curr Opin Nephrol Hypertens 2012; 21:106-18. [DOI: 10.1097/mnh.0b013e32834ee42b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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