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Behzadnia N, Esmaeilinejad K, Rashid-Farokhi F, Pourdowlat G. Contributing Factors of Pulmonary Hypertension in Hemodialysis Patients. TANAFFOS 2023; 22:375-381. [PMID: 39176142 PMCID: PMC11338510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/18/2023] [Indexed: 08/24/2024]
Abstract
Background Pulmonary hypertension (PH) is a known complication of hemodialysis (HD) but its pathogenesis and etiology is not completely clear. The purpose of the current study is to determine the prevalence and possible causes of PH among hemodialysis patients. Material and Methods Demographic, clinical and laboratory data of 40 patients referred to hemodialysis ward of Masih Daneshvari Hospital during 12 months were recorded. Detailed echocardiography was performed for each patient within 24 hours of hemodialysis. PH was defined as systolic pulmonary artery pressure (SPAP) above 35 mmHg. Results 12 of 40 HD patients had PH (prevalence = 30%). The hemodialysis vintage in PH group was longer than patients without PH (No PH group) . Also, left atrium size, right ventricle size, left ventricle end diastolic diameter (LVEDD) and left ventricular mass index (LV mass index) were significantly higher in PH group; but ejection fraction (EF) was lower than No PH group. Left ventricle diastolic dysfunction and pericardial effusion were significantly associated with PH. The crude mortality rate was relatively similar in PH group and No PH group. Conclusion PH is prevalent in HD patients with multifactorial etiology. Increased pulmonary capillary wedge pressure (PCWP) is a very important factor to induce PH in these patients; on the other hand, chronic volume overload and left ventricle systolic and diastolic dysfunction are some of the predominant causes of increased PCWP in this population.
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Affiliation(s)
- Neda Behzadnia
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Komeil Esmaeilinejad
- Chronic Respiratory Disease Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farin Rashid-Farokhi
- Telemedicine Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Guitti Pourdowlat
- Chronic Respiratory Disease Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Nekooeian M, Ezzatzadegan Jahromi S, Masjedi F, Sohooli M, Shekouhi R, Moaref A. The significance of volume overload in the development of pulmonary arterial hypertension in continuous ambulatory peritoneal dialysis patients. Ther Apher Dial 2022. [PMID: 36579477 DOI: 10.1111/1744-9987.13965] [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: 06/18/2022] [Revised: 12/19/2022] [Accepted: 12/23/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The underlying pathophysiology of pulmonary arterial hypertension (PAH) is multifactorial; however, the significance of chronic volume overload and its subsequent effects on cardiac function must be studied thoroughly. The main objective of this study was to determine the predictive parameters of PAH in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) using transthoracic echocardiography (TTE) and bioimpedance analysis (BIA). METHODS In this cross-sectional study, 43 eligible CAPD patients were chosen. The patients were examined by TTE and BIA before the morning dialysis session, and baseline patient characteristics, echocardiography, and BIA parameters were recorded. RESULTS Sixteen (37.2%) patients were diagnosed with PAH. Patients with PAH had significantly greater left atrial diameter (LAD), left ventricular mass index (LVMI), and higher grades of diastolic dysfunction (DDF). Systolic pulmonary artery pressure (sPAP) correlated with LAD (p < 0.001, r = 0.566), interventricular septal diameter (IVSD) (p = 0.004, r = 0.425), LVMI (p = 0.030, r = 0.323), and extracellular water/total body water (ECW/TBW) ratio (p = 0.002, r = 0.458). CONCLUSION Two volume status-related parameters including ECW/TBW ratio and inferior vena cava (IVC) expiratory diameter, and cardiac-related TTE findings such as LAD and DDF were predictors of sPAP in CAPD patients.
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Affiliation(s)
- Mohammad Nekooeian
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahrokh Ezzatzadegan Jahromi
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Internal Medicine, School of Medicine, Shiraz University of Medical Science, Shiraz, Iran
| | - Fatemeh Masjedi
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Sohooli
- Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ramin Shekouhi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.,Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Moaref
- Department of Cardiology, School of Medicine, Shiraz University of Medical Science, Shiraz, Iran.,Cardiovascular Research Center, Shiraz University of Medical Science, Shiraz, Iran
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Alhwiesh AK, Abdul-Rahman IS, Alshehri A, Alhwiesh A, Elnokeety M, Essam S, Sakr M, Al-Oudah N, Abdulrahman A, Mohammed AM, Mansour H, El-Salamoni T, Al-Oudah N, Alayoobi L, Aljenaidi H, Al-Harbi A, Mousa D, Abdulnasir A, Skhiri S. The problem of pulmonary arterial hypertension in end-stage renal disease: can peritoneal dialysis be the solution. BMC Nephrol 2022; 23:386. [PMID: 36471276 PMCID: PMC9721065 DOI: 10.1186/s12882-022-02998-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/02/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) in the setting of end-stage renal disease (ESRD) has important prognostic and therapeutic consequences. We estimated the prevalence of PAH among patients with ESRD treated with automated peritoneal dialysis (APD), investigated the effect of different variables and compared pulmonary artery pressure and cardiac function at the beginning and end of the study. METHODS This is a 5-year study in which 31 ESRD patients on APD were recruited after fulfilling inclusion criteria. Blood samples were collected from all patients for the biochemical and hematological data at the beginning of the study and every month and at the study termination. Total body water (TBW) and extracellular water (ECW) were calculated using Watson's and Bird's calculation methods. All patients were followed-up at 3-month interval for cardiac evaluation. Logistic regression analysis was used to assess the relation between different variables and PAH. RESULTS The mean age of the study population (n = 31) was 51.23 ± 15.24 years. PAH was found in 24.2% of the patients. Mean systolic pulmonary artery pressure (sPAP) and mean pulmonary artery pressure (mPAP) were significantly higher in the APD patients at study initiation than at the end of the study (40.75 + 10.61 vs 23.55 + 9.20 and 29.66 + 11.35 vs 18.24 + 6.75 mmHg respectively, p = 0.001). The median ejection fraction was significantly lower in patients with PAH at zero point than at study termination [31% (27-34) vs 50% (46-52), p = 0.002]. Hypervolemia decreased significantly at the end of study (p < 0.001) and correlated positively with the PAP (r = 0.371 and r = 0.369), p = 0.002). sPAP correlated with left ventricular mass index, hemoglobin level, and duration on APD. CONCLUSIONS Long term APD (> 1 years) seemed to decrease pulmonary arterial pressure, right atrial pressure and improve left ventricular ejection fraction (LVEF). Risk factors for PAH in ESRD were hypervolemia, abnormal ECHO findings and low hemoglobin levels. Clinical and echocardiographic abnormalities and complications are not uncommon among ESRD patients with PAH. Identification of those patients on transthoracic echocardiography may warrant further attention to treatment with APD.
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Affiliation(s)
- Abdullah K. Alhwiesh
- grid.411975.f0000 0004 0607 035XNephrology Division, Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, 1952 Saudi Arabia
| | - Ibrahiem Saeed Abdul-Rahman
- grid.411975.f0000 0004 0607 035XNephrology Division, Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, 1952 Saudi Arabia
| | - Abdullah Alshehri
- grid.411975.f0000 0004 0607 035XCardiology Division, Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Amani Alhwiesh
- grid.411975.f0000 0004 0607 035XNephrology Division, Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, 1952 Saudi Arabia
| | - Mahmoud Elnokeety
- grid.411975.f0000 0004 0607 035XNephrology Division, Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, 1952 Saudi Arabia
| | - Syed Essam
- grid.411975.f0000 0004 0607 035XNephrology Division, Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, 1952 Saudi Arabia
| | - Mohamad Sakr
- grid.411975.f0000 0004 0607 035XNephrology Division, Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, 1952 Saudi Arabia
| | - Nadia Al-Oudah
- grid.411975.f0000 0004 0607 035XNephrology Division, Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, 1952 Saudi Arabia
| | - Abdulla Abdulrahman
- grid.410356.50000 0004 1936 8331Department of Electrical Engineering, Queen’s University, Toronto, Kingston, Canada
| | - Abdelgalil Moaz Mohammed
- grid.411975.f0000 0004 0607 035XNephrology Division, Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, 1952 Saudi Arabia
| | - Hany Mansour
- grid.411975.f0000 0004 0607 035XNephrology Division, Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, 1952 Saudi Arabia
| | - Tamer El-Salamoni
- grid.411975.f0000 0004 0607 035XNephrology Division, Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, 1952 Saudi Arabia
| | - Nehad Al-Oudah
- grid.411975.f0000 0004 0607 035XNephrology Division, Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, 1952 Saudi Arabia
| | - Lamees Alayoobi
- grid.411975.f0000 0004 0607 035XNephrology Division, Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, 1952 Saudi Arabia
| | - Hend Aljenaidi
- grid.411975.f0000 0004 0607 035XNephrology Division, Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, 1952 Saudi Arabia
| | - Ali Al-Harbi
- Diaverum Al-Majdoie Dialysis Center, Dammam, Eastern Province Saudi Arabia
| | - Dujanah Mousa
- Diaverum Al-Majdoie Dialysis Center, Dammam, Eastern Province Saudi Arabia
| | | | - Sami Skhiri
- Diaverum Al-Majdoie Dialysis Center, Dammam, Eastern Province Saudi Arabia
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Echocardiographic changes after arteriovenous fistula creation in hemodialysis patients. Clin Nephrol 2022; 98:229-238. [PMID: 36168799 PMCID: PMC9990444 DOI: 10.5414/cn110816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Pulmonary hypertension (PH) is common in end-stage renal disease (ESRD) patients and is associated with increased all-cause and cardiovascular mortality in this group. There is scarce data on the long-term effect of arteriovenous fistula (AVF) creation on pulmonary hypertension (PH) and the reflected changes in echocardiographic measurements. MATERIALS AND METHODS This is a retrospective study of 54 patients who underwent AVF creation between 2009 and 2014 and with echocardiographic evaluations before and after surgery. We analyzed pairwise changes in right ventricular systolic pressure (RVSP), right atrial pressure (RAP) during systole, left ventricular mass (LVM), tricuspid regurgitation (TR), mitral E/E' ratio, and ejection fraction (EF), as well as the factors that predicted change in RVSP after surgery. RESULTS The median time for the preoperative echocardiogram was 0.3 years (interquartile range (IQR) 0.2 - 0.7 years) prior to AVF creation, while the follow-up echo was done 1.3 (0.6 - 2.1) years after surgery. 67% of the patients had RVSP > 37 mmHg at baseline. There was a significant reduction in RVSP after AVF creation compared to baseline (median 33 (IQR 26 - 43) vs. 46 mmHg, p = 0.0015), with 59% of the patients experiencing a decrease and 19% remaining stable. There were also significant decreases in LVM (201 (143 - 256) vs. 215 (163 - 276), p = 0.045) and RAP systole (10 (10 - 15) vs. 3 (3 - 8); p < 0.001) after surgery. Higher preoperative weight (p = 0.038) and RVSP (p = 0.006), and use of loop diuretics (p = 0.015) were significantly associated with improvement in RVSP after AVF creation. CONCLUSION Our results suggest that AVF creation is associated with a significant reduction or stable measurements of RVSP in the ESRD population, likely due to an improvement in volume status.
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Nagaraju SP, Bhojaraja MV, Paramasivam G, Prabhu RA, Rangaswamy D, Rao IR, Shenoy SV. Risk Factors of Pulmonary Hypertension in Patients on Hemodialysis: A Single Center Study. Int J Nephrol Renovasc Dis 2022; 14:487-494. [PMID: 34992427 PMCID: PMC8713877 DOI: 10.2147/ijnrd.s346184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/09/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction Pulmonary hypertension (PH) is an underestimated cardiovascular consequence and a mortality predictor in patients on hemodialysis (HD). Thus, we studied its prevalence, risk factors, association with inflammation/oxidative stress, and cardiac changes in HD patients. Methods This was a single-center cross-sectional observational study conducted at a tertiary care hospital. Patients aged >18 years on hemodialysis for at least three months were included and divided into those with and without PH; patients with secondary causes for PH were excluded. Clinical characteristics, HD-related factors, lab parameters (C-reactive protein and malondialdehyde with thiol assay were used as markers of inflammation and oxidative stress, respectively), and echocardiography details were compared. PH was defined as a mean pulmonary artery pressure of >25 mmHg at rest, and it was further divided as mild (25–40 mmHg), moderate (40–60 mmHg), and severe (>60 mmHg). Results Of 52 patients, 28 patients had PH (mild 24, moderate 4, and none had severe PH) with prevalence of 54%. No difference was found in clinical characteristics, dialysis-related factors, biochemical parameters including inflammation (C-reactive protein; p=0.76), or oxidative stress (thiol; p=0.36 and MDA; p=0.46) between the groups. When compared to individuals without PH, HD patients with PH exhibited significantly more mitral regurgitation (p=0.002). Conclusion Hemodialysis patients have a high prevalence of PH. PH was significantly associated with the presence of mitral regurgitation on echocardiography. Our study did not find differences in traditional risk factors, HD-related factors, and inflammation/oxidative markers between the groups with and without PH.
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Affiliation(s)
- Shankar Prasad Nagaraju
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy Higher Education, Manipal, Karnataka, 576104, India
| | - Mohan V Bhojaraja
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy Higher Education, Manipal, Karnataka, 576104, India
| | - Ganesh Paramasivam
- Department of Cardiology, Kasturba Medical College, Manipal, Manipal Academy Higher Education, Manipal, Karnataka, 576104, India
| | - Ravindra Attur Prabhu
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy Higher Education, Manipal, Karnataka, 576104, India
| | - Dharshan Rangaswamy
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy Higher Education, Manipal, Karnataka, 576104, India
| | - Indu Ramachandra Rao
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy Higher Education, Manipal, Karnataka, 576104, India
| | - Srinivas Vinayak Shenoy
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy Higher Education, Manipal, Karnataka, 576104, India
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Girsberger M, Chan CT. Retrospective single center cohort study: effect of intensive home hemodialysis on right ventricular systolic pressure and clinical outcomes. BMC Nephrol 2020; 21:508. [PMID: 33238914 PMCID: PMC7687753 DOI: 10.1186/s12882-020-02159-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 11/10/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Increased right ventricular systolic pressure (RVSP), a surrogate marker for pulmonary hypertension, is common in patients with end-stage kidney disease. Limited data suggest improvement of RVSP with intensive dialysis, but it is unknown whether these improvements translate to better clinical outcomes. METHODS We conducted a retrospective single center cohort study at the Toronto General Hospital. All patients who performed intensive home hemodialysis (IHHD) for at least a year between 1999 and 2017, and who had a baseline as well as a follow-up echocardiogram more than a year after IHHD, were included. Patients were categorized into two groups based on the RVSP at follow-up: elevated (≥ 35 mmHg) and normal RVSP. Multivariate and cox regression analyses were done to identify risk factors for elevated RVSP at follow-up and reaching the composite endpoint (death, cardiovascular hospitalization, treatment failure), respectively. RESULTS One hundred eight patients were included in the study. At baseline, 63% (68/108) of patients had normal RVSP and 37% (40/108) having elevated RVSP. After a follow-up of 4 years, 70% (76/108) patient had normal RVSP while 30% (32/108) had elevated RVSP. 8 (10%) out of the 76 patients with normal RVSP and 15 (47%) out of the 32 patients with elevated RVSP reached the composite endpoint of death, cardiovascular hospitalization or technique failure. In a multivariate analysis, age, diabetes and smoking were not associated with elevated RVSP at follow-up. Elevated RVSP at baseline was not associated with a higher likelihood in reaching the composite endpoint or mortality. CONCLUSION Mean RVSP did not increase in patients on IHHD over time, and maintenance of normal RVSP was associated with better clinical outcomes.
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Affiliation(s)
- Michael Girsberger
- Division of Nephrology, University Health Network, 200 Elizabeth Street, 8N room 846, Toronto, ON, M5G 2C4, Canada
| | - Christopher T Chan
- Division of Nephrology, University Health Network, 200 Elizabeth Street, 8N room 846, Toronto, ON, M5G 2C4, Canada.
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Engole YM, Lepira FB, Nlandu YM, Lubenga YS, Longo AL, Nkodila A, Makulo JRR, Mokoli VM, Bukabau JB, Mboliasa MFI, Kadima EM, Ilunga CK, Mvunzi TS, Nseka NM, Sumaili EK. Prevalence and factors associated with pulmonary arterial hypertension on maintenance hemodialysis patients in Kinshasa, Democratic Republic of Congo: a cross-sectional study. BMC Nephrol 2020; 21:460. [PMID: 33148221 PMCID: PMC7640388 DOI: 10.1186/s12882-020-02131-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 10/27/2020] [Indexed: 11/11/2022] Open
Abstract
Background Although cardiovascular diseases in particular Pulmonary Arterial Hypertension (PAH) is associated with, high morbid-mortality in chronic hemodialysis, but its magnitude remains paradoxically unknown in sub-Saharan Africa. The aim of this study was to evaluate the prevalence of PAH and associated factors in chronic hemodialysis in Sub-Saharan African population. Method In a cross-sectional study, patients treated with HD for at least 6 months in 4 hemodialysis centers were examined. PAH was defined as estimated systolic pulmonary arterial pressure (sPAP) ≥ 35 mmHg using transthoracic Doppler echocardiography performed 24 h after the HD session. Results Eighty-five HD patients were included; their average age was 52.6 ± 15.9 years. Fifty-seven patients (67.1%) were male. Mean duration of HD was 13.3 ± 11 months. With reference to vascular access, 12 (14.1%), 29 (34.1%) and 44 (51.8%) patients had AVF, tunneled cuff and temporary catheter, respectively. The underlying cause of ESRD was diabetes in 30 patients (35.3%). The prevalence of PAH was 29.4%. Patients with PAH had more hyponatremia (11 (44%) vs 10 (16.7%), p = 0.010). In multivariate analysis, unsecured healthcare funding (aOR 4, 95% CI [1.18–6.018]), arrhythmia (aOR 3, 95% CI [1.29–7.34]), vascular access change (aOR 4, 95% CI [1.18–7.51]) and diastolic dysfunction (aOR 5, 95% CI [1.35–9.57] were independently associated with PAH. Conclusion One third of hemodialysis patients exhibit PAH, which is independently associated with low socioeconomic status (unsecured funding, vascular access change) and cardiovascular complications (arrhythmia, diastolic dysfunction).
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Affiliation(s)
- Yannick Mompango Engole
- Nephrology Unit, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo.
| | - François Bompeka Lepira
- Nephrology Unit, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Yannick Mayamba Nlandu
- Nephrology Unit, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Yves Simbi Lubenga
- Cardiology Unit, University Hospital of Kinshasa, BP: 123, Kinshasa, XI, Democratic Republic of the Congo
| | | | - Aliocha Nkodila
- Nephrology Unit, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | - Vieux Momeme Mokoli
- Nephrology Unit, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Justine Busanga Bukabau
- Nephrology Unit, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | - Evariste Mukendi Kadima
- Nephrology Unit, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Cedric Kabemba Ilunga
- Nephrology Unit, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Tresor Swambulu Mvunzi
- Cardiology Unit, University Hospital of Kinshasa, BP: 123, Kinshasa, XI, Democratic Republic of the Congo
| | - Nazaire Mangani Nseka
- Nephrology Unit, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Ernest Kiswaya Sumaili
- Nephrology Unit, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
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Relationship Between Parathyroid Hormone and Pulmonary Artery Hypertension Among Patients Undergoing Hemodialysis. Nephrourol Mon 2020. [DOI: 10.5812/numonthly.104448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Pulmonary artery hypertension (PAH) is linked with morbidity and mortality in hemodialysis (HD) patients. The relationship between serum parathyroid hormone (PTH) and PAH is still a subject of debate. Objectives: The goal of the present study was to assess the association between PTH and PAH among HD patients. Methods: This was a cross-sectional study that assessed HD patients in a tertiary hospital in Mashhad, Iran. Echocardiography was performed for all patients to measure pulmonary artery pressure (PAP) and ejection fraction. Laboratory data, including serum calcium, phosphorus, vitamin D, serum albumin, and alkaline phosphatase, were extracted from patient documents. The statistical tests included independent t-test, Mann-Whitney, chi-squared test, and logistic regression. Results: A total of 78 patients (43 males and 35 females) participated in this study. The mean age was 37.25 ± 11.98 years old. There was a significant difference in the PAH distribution pattern between hyperparathyroidism and normal PTH groups (P = 0.003). PAH was significantly related to hyperparathyroidism (P = 0.004, OR = 4.557), age (P = 0.033, OR = 0.944), and calcium level (P = 0.005, OR = 0.336). After adjusting for other variables, the odds ratio for the relationship between PAH and hyperparathyroidism increased to 7.593. Conclusions: The findings of this study supported the possible link between hyperparathyroidism, serum calcium level, and PAH in HD patients.
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9
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Schoenberg NC, Argula RG, Klings ES, Wilson KC, Farber HW. Prevalence and Mortality of Pulmonary Hypertension in ESRD: A Systematic Review and Meta-analysis. Lung 2020; 198:535-545. [DOI: 10.1007/s00408-020-00355-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/20/2020] [Indexed: 01/08/2023]
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10
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Mehta KS, Shirkande AK, Bhurke SP, Pajai AE, Swami RS, Jadhav SN. Pulmonary Hypertension in Various Stages of Chronic Kidney Disease in Indian Patients. Indian J Nephrol 2019; 29:95-101. [PMID: 30983749 PMCID: PMC6440332 DOI: 10.4103/ijn.ijn_407_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The prevalence of pulmonary hypertension (PH) in chronic kidney disease (CKD) in Indian patients has been evaluated in this study. In addition, association of PH with CKD etiology, its prevalence in various CKD stages, correlation between the severity of PH with CKD duration, various related biochemical parameters, and their relation to PH in CKD patients were analyzed. This cross-sectional and prospective study included 200 CKD patients. Detailed history and clinical examination were recorded. Hemoglobin, blood urea nitrogen (BUN), serum creatinine, albumin, and calcium-phosphorus product were recorded. Pulmonary function test was evaluated and two-dimensional echo was done 4 hours post dialysis. The prevalence of PH in CKD patients was 60.5%, with mean pulmonary artery systolic pressure (PASP) of 38.52 ± 7.32 mmHg. The mean age of those with PH was 47.85 ± 13.09 years. PH was more common in males (p = 0.03). The prevalence of PH increased as CKD stage advanced (p < 0.001). Diabetes and hypertension had a strong association with PH (p < 0.001). The prevalence (p = 0.003) and severity (p = 0.011) of PH increased with increase in CKD duration. In patients on hemodialysis (HD), the prevalence (p < 0.001) and severity (p = 0.022) of PH was significant compared to those on conservative treatment. The prevalence (p < 0.001) and severity (p < 0.001) of PH significantly increased as duration of HD increased. The prevalence of PH was significantly higher in patients with arteriovenous fistula (p = 0.002). Serum creatinine (p = 0.02) and serum calcium-phosphorus product (p < 0.001) were significantly higher in patients with PH. The prevalence of PH in CKD patients was 60.5%. There was a positive correlation between PH and duration of CKD, duration of HD, BUN, serum creatinine, and serum calcium-phosphorus product.
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Affiliation(s)
- Kalpana S Mehta
- Department of Nephrology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Abhishek K Shirkande
- Department of Nephrology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Sandip P Bhurke
- Department of Nephrology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Atim E Pajai
- Department of Nephrology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Rudramani S Swami
- Department of Nephrology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Swapnil N Jadhav
- Department of Nephrology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, Maharashtra, India
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Girsberger M, Thenganatt J, Chan CT. Correction of pulmonary hypertension with intensive hemodialysis: A case report. Hemodial Int 2019; 23:E49-E52. [DOI: 10.1111/hdi.12691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/06/2018] [Indexed: 11/29/2022]
Affiliation(s)
| | - John Thenganatt
- Division of RespirologyUniversity Health Network Toronto Canada
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Jarmi T, Doumit E, Makdisi G, Mhaskar R, Miladinovic B, Wadei H, Rumbak M, Aslam S. Pulmonary Artery Systolic Pressure Measured Intraoperatively by Right Heart Catheterization Is a Predictor of Kidney Transplant Recipient Survival. Ann Transplant 2018; 23:867-873. [PMID: 30559336 PMCID: PMC6319438 DOI: 10.12659/aot.911176] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The effect of pulmonary artery systolic pressure (PASP) measured by Swan-Ganz right heart catheter (SG-RHC) on kidney transplant recipient survival has not been previously studied. The objective of this study was to assess the relationships between PASP measured via SG-RHC, done intraoperatively at the time of initiating anesthesia at the beginning of kidney transplant surgery, and patient survival. Multiple comorbidities, time on dialysis before the transplantation, and graft function were also analyzed in our study. MATERIAL AND METHODS This was a retrospective cohort study using data from all consecutive patients undergoing kidney transplant between January 1, 2005 and December 31, 2009 at Tampa General Hospital. Kidney transplant recipients were divided into 2 groups: Group 1 with PASP <35 mmHg and group 2 with PASP ≥35 mmHg. Patients and graft survival data, time on dialysis before transplant, and comorbidities were compared between the 2 groups. RESULTS Only 363 patients were found to have a documented PASP measurement at the time of anesthesia induction for the transplant surgery, and were included in the specific analysis of our study. Patients with PASP ≥35 mmHg showed a significant decrease in survival in comparison to patients having PASP values <35 mmHg (HR 1.88; 95% CI 1.012 to 3.47, P=0.04). There was a significant positive correlation between time on dialysis and PASP (rho 0.20; 95% CI 0.09 to 0.30, p<0.001), as well as a significant difference in median time on dialysis between PASP <35 vs. PASP ≥35 (22 vs. 29 months, p=0.004). There were no significant differences in graft failure between the 2 PASP groups (HR 0.34; 95% CI 0.12 to 1.01, P=0.05). CONCLUSIONS Patients with PASP ≥35 mmHg, measured intraoperatively by SG-RHC, showed significantly shorter survival in comparison to patients having PASP values <35 mmHg. This result suggests the need for a randomized controlled trial to address the importance of post-transplant pulmonary hypertension management in patient survival.
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Affiliation(s)
- Tambi Jarmi
- Division of Nephrology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Elias Doumit
- Division of Nephrology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - George Makdisi
- Department of Surgery, Division of Thoracic and Cardiovascular, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Rahul Mhaskar
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Branko Miladinovic
- Program for Comparative Effectiveness Research and Evidence-Based Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Hani Wadei
- Transplant Center, Mayo Clinic, Jacksonville Campus, Jacksonville, FL, USA
| | - Mark Rumbak
- Department of Pulmonary Critical Care and Sleep Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Sadaf Aslam
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
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Prevalence of pulmonary hypertension in peritoneal dialysis patients: a meta-analysis. Int Urol Nephrol 2018; 51:175-180. [PMID: 30456547 DOI: 10.1007/s11255-018-2017-4] [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: 07/23/2018] [Accepted: 10/22/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Recent epidemiological evidence indicates an association between peritoneal dialysis (PD) patients and pulmonary hypertension (PH). However, the true prevalence of PH associated with PD has not been well described. So we conducted a meta-analysis to summarize the point prevalence of PH in adults with PD. 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. We also performed sensitivity analyses and assessments of publishing bias. RESULTS Fourteen observational studies (n = 1483 participants) were included in this meta-analysis. The result of analysis in random-effect model showed that the pooled prevalence was 21% (95% CI 16-28), with significant heterogeneity between these studies (I2 = 84%, p < 0.01). Sensitivity analysis further demonstrated the results to be robust. Besides, the Egger's test (p = 0.287) showed no significant publication bias. CONCLUSIONS PH is highly prevalent in patients with PD. Further studies are encouraged to definitively clarify the relationship between PH and PD.
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Peter ID, Asani MO, Aliyu I, Obiagwu PN. Elevated Mean Pulmonary Artery Pressure and Right Ventricular Dysfunction in Children with Chronic Kidney Disease. J Cardiovasc Echogr 2018; 28:109-113. [PMID: 29911007 PMCID: PMC5989541 DOI: 10.4103/jcecho.jcecho_56_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Elevated mean pulmonary artery pressure (mPAP) and right heart failure increase mortality in patients with chronic kidney disease (CKD). Objectives The objective of this study is to determine the prevalence of elevated mPAP in children with CKD compared with matched controls and to ascertain the relationship between elevated mPAP with right ventricular dysfunction and history of hemodialysis. Materials and Methods A cross-sectional comparative study of mPAP and tricuspid annular plane systolic excursion of 21 children with CKD and age- and sex-matched controls asymptomatic for cardiac disease was conducted. Results Median mPAP was 27.69 (18.3-36.1) mmHg in CKD patients compared with 14.55 (13.5-17.1) mmHg in controls (P = 0.002). Elevated mPAP was present in 42.9% of CKD group and 0% in controls (P < 0.001). The prevalence of right ventricle (RV) dysfunction in CKD was 9.5% and 0% in controls (P = 0.49). Right ventricular dysfunction was significantly more common in patients with elevated mPAP compared with those with normal mPAP (P < 0.001). Children with CKD who had a history of having been dialyzed were less likely to have elevated mPAP (P < 0.001). Conclusion Elevated mPAP is significantly more common in children with CKD compared with controls. CKD population with mPAP elevation is more likely to have impaired RV function. The occurrence of elevated mPAP was more common in those who were never dialyzed.
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Affiliation(s)
- Igoche D Peter
- Paediatric Cardiology Unit, Aminu Kano Teaching Hospital, Bayero University Kano, Nigeria
| | - Mustafa O Asani
- Paediatric Cardiology Unit, Aminu Kano Teaching Hospital, Bayero University Kano, Nigeria
| | - Ibrahim Aliyu
- Paediatric Cardiology Unit, Aminu Kano Teaching Hospital, Bayero University Kano, Nigeria
| | - Patience N Obiagwu
- Department of Paediatrics, Paediatric Nephrology Unit, Aminu Kano Teaching Hospital, Bayero University Kano, Nigeria
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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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D-Shaped Left Ventricle, Anatomic, and Physiologic Implications. Case Rep Cardiol 2017; 2017:4309165. [PMID: 29302368 PMCID: PMC5742444 DOI: 10.1155/2017/4309165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 08/18/2017] [Accepted: 09/07/2017] [Indexed: 11/20/2022] Open
Abstract
Right ventricular loading/pressure influences left ventricular function because the two ventricles pump in series and because they are anatomically arranged in parallel, sharing the common ventricular septum. Flattening of the interventricular septum detected during echocardiographic examination is called D-shaped left ventricle. We present a case of an elderly male of African descent, who presented with increased shortness of breath. Transthoracic echocardiogram showed flattening and left sided deviation of interventricular septum causing a decreased size in left ventricle, secondary to volume/pressure overload in the right ventricle. While patient received hemodialysis therapy and intravascular volume was removed, patient blood pressure was noted to increase, paradox. Repeated transthoracic echocardiogram demonstrated less left deviation of interventricular septum compared with previous echocardiogram. We consider that it is important for all physicians to be aware of the anatomic and physiologic implication of D-shaped left ventricle and how right ventricle pressure/volume overload affects its function and anatomy.
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Hayati F, Beladi Mousavi SS, Mousavi Movahed SM, Mofrad Bushehri M. Pulmonary hypertension among patients undergoing hemodialysis. J Renal Inj Prev 2016; 6:122-126. [PMID: 28497088 PMCID: PMC5423279 DOI: 10.15171/jrip.2017.24] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 10/25/2016] [Indexed: 11/12/2022] Open
Abstract
Introduction: The epidemiology of pulmonary hypertension (PHT) among long-term hemodialysis patients has been described in relatively small studies in Iran.
Objectives: The purpose of this study was to evaluate the prevalence of PHT and its relationship among end-stage renal disease (ESRD) patients undergoing long-term hemodialysis (HD).
Patients and Methods: In a cross-sectional study, patients with ESRD treated with HD for at least 3 months in the Imam hospital enrolled for the study. PHT was defined as an estimated systolic pulmonary artery pressure (PAP) equal to or higher than 25 mm Hg using echocardiograms performed by cardiologist.
Results: A total of 69 HD patients were included in the investigation. The mean of age of our patients was 52.6±15.3 years. The mean duration of HD was 39±36 months. The mean ejection fraction was 45±7%. The prevalence of PHT was 62.3%. These patients were more likely to have lower ejection fraction. The PHT was more common among female HD patients. We did not find any association between PHT and cause of ESRD, duration of HD, anemia and serum calcium, phosphor and parathyroid hormone levels.
Conclusion: Our findings show that PHT is a common problem among ESRD patients undergoing maintenance HD and it is strongly associated with heart failure. It is necessary to screen this disorder among these patients.
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Affiliation(s)
- Fatemeh Hayati
- Chronic Renal Failure Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Seyed Seifollah Beladi Mousavi
- Chronic Renal Failure Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Department of Internal Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Maryam Mofrad Bushehri
- Chronic Renal Failure Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Cardiorenal syndrome type 4: A study of cardiovascular diseases in chronic kidney disease. Indian Heart J 2016; 69:11-16. [PMID: 28228293 PMCID: PMC5319008 DOI: 10.1016/j.ihj.2016.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 06/06/2016] [Accepted: 07/02/2016] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION The heart and the kidneys are tightly interlinked with each other. So, primary disorder of one of these organs often results in the secondary dysfunction of other. Such interactions play a vital role in the pathogenesis of a clinical entity called cardio-renal syndrome (CRS). CRS type 4 refers to the development of cardiac failure in the patients with CKD. OBJECTIVES To study the prevalence of various cardiac diseases in the patients with CKD and risk factors for it. METHODS Eighty patients with CKD who were being treated at KIMS, Hubli, from 1st January 2015 to 30th June 2015 were selected. Clinical evaluation and relevant investigations including echocardiography were done. RESULTS Mean age of study population was 43.50±14.53 years. Heart failure with reduced ejection fraction (HFrEF) and Heart Failure with preserved ejection fraction (HFpEF) were present in 21 (26.25%) and 59 (73.75%) respectively. Left ventricular (LV) hypertrophy was present in 55(68.75%). Thus, the prevalence of CRS type 4 was 61 (76.25%). Pericardial effusion was present in 12 (15%). Complete heart block was present in 2 (2.5%). Pulmonary hypertension (PH) was present in 35 (43.75%). Mean central venous pressure (CVP) and interdialysis fluid retention were significantly greater among those with LV failure, compared to those without LV failure (p=0.0002, p=0.025 respectively). Mean hemoglobin was significantly lower among patients with LV failure, compared to those without LV failure (p=0.032). CONCLUSION The prevalence of cardiorenal syndrome type 4 is substantially high in patients with CKD and carries adverse outcome in relation to patient management.
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Faqih SA, Noto-Kadou-Kaza B, Abouamrane LM, Mtiou N, El Khayat S, Zamd M, Medkouri G, Benghanem MG, Ramdani B. Pulmonary hypertension: prevalence and risk factors. IJC HEART & VASCULATURE 2016; 11:87-89. [PMID: 28616531 PMCID: PMC5462628 DOI: 10.1016/j.ijcha.2016.05.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 05/02/2016] [Indexed: 11/26/2022]
Abstract
Introduction Pulmonary arterial hypertension (PAH), defined as a systolic pulmonary artery pressure above 35 mm Hg, is another vascular disease entity recently described in patients receiving hemodialysis. It is a major problem due to its high prevalence and morbidity and mortality. Its pathophysiological mechanism is just known and the strategies for its supported not yet defined. Aims To determine the prevalence of PAH in our hemodialysis patients and its risk factors. Methodology Single center descriptive and analytical cross-sectional study, including 111 hemodialysis patients who had benefit from a trans-thoracic cardiac Doppler ultrasound during 2014. A value greater than or equal to 35 mm Hg is considered PAH and classified as follows: mild PAH (35 50 mm Hg), moderate PAH (50 70 mm Hg), and severe pulmonary hypertension (> 70 mm Hg). Patients with a high probability of secondary PAH, especially those with the following history: chronic obstructive pulmonary disease, pulmonary embolism, were not included. Results The mean age was 44.3 ± 14.2 years. Among the 111 patients, 18 had pulmonary arterial pressure above 35 mm Hg corresponding to 16.22% of PAH prevalence. The average pressure was 45 mm Hg. Of these 18 patients, 11.8% had mild PAH, 3.4% moderate PAH and 0.8% severe PAH. The average hemodialysis duration was significantly associated with PAH (p = 0.003); as well as valvular calcification (p = 0.000), mitral regurgitation (p = 0.001) and tricuspid regurgitation (p = 0.002). Conclusion Primary pulmonary hypertension is a major problem among our hemodialysis because of its high prevalence and its risk factors.
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Affiliation(s)
- Samia Ait Faqih
- Department of Nephrology, Dialysis and Renal Transplantation, Ibn Rochd University Hospital of Casablanca, 1, Quartier des Hôpitaux, Casablanca 20100, Morocco
| | - Béfa Noto-Kadou-Kaza
- Department of Nephrology, Dialysis and Renal Transplantation, Ibn Rochd University Hospital of Casablanca, 1, Quartier des Hôpitaux, Casablanca 20100, Morocco
| | - Lalla Meryam Abouamrane
- Department of Nephrology, Dialysis and Renal Transplantation, Ibn Rochd University Hospital of Casablanca, 1, Quartier des Hôpitaux, Casablanca 20100, Morocco
| | - Naoufal Mtiou
- Department of Nephrology, Dialysis and Renal Transplantation, Ibn Rochd University Hospital of Casablanca, 1, Quartier des Hôpitaux, Casablanca 20100, Morocco
| | - Selma El Khayat
- Department of Nephrology, Dialysis and Renal Transplantation, Ibn Rochd University Hospital of Casablanca, 1, Quartier des Hôpitaux, Casablanca 20100, Morocco
| | - Mohamed Zamd
- Department of Nephrology, Dialysis and Renal Transplantation, Ibn Rochd University Hospital of Casablanca, 1, Quartier des Hôpitaux, Casablanca 20100, Morocco
| | - Ghislaine Medkouri
- Department of Nephrology, Dialysis and Renal Transplantation, Ibn Rochd University Hospital of Casablanca, 1, Quartier des Hôpitaux, Casablanca 20100, Morocco
| | - Mohamed Gharbi Benghanem
- Department of Nephrology, Dialysis and Renal Transplantation, Ibn Rochd University Hospital of Casablanca, 1, Quartier des Hôpitaux, Casablanca 20100, Morocco
| | - Benyounes Ramdani
- Department of Nephrology, Dialysis and Renal Transplantation, Ibn Rochd University Hospital of Casablanca, 1, Quartier des Hôpitaux, Casablanca 20100, Morocco
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Zhang L, Zhao S, Ma J, Gong J, Qiu G, Ren Y, Zen Y, Shi Y. Prevalence and risk factors for pulmonary arterial hypertension in end-stage renal disease patients undergoing continuous ambulatory peritoneal dialysis. Ren Fail 2016; 38:815-21. [PMID: 26888091 DOI: 10.3109/0886022x.2015.1103637] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) is a major complication in renal failure patients, but very little information is available on the cardiovascular parameters in these patients. The prevalence and risk factors for PAH were systematically evaluated in patients with end-stage renal diseases (ESRD) undergoing continuous ambulatory peritoneal dialysis (CAPD). METHODS Between January 2010 and January 2014, 177 ESRD patients (85 males and 92 females) undergoing CAPD therapy were recruited. General data, biochemical parameters and echocardiographic findings were collected and PAH risk factors studied. RESULTS Study participants consisted of 65 patients (36.52%) with PAH (PAH group) and 112 patients without PAH (non-PAH group). The interdialytic weight gain, systolic blood pressure and diastolic blood pressure (DBP), mean arterial pressure and hypertensive nephropathy incidence in the PAH group were significantly higher than the non-PAH group (all p < 0.05). There were significant differences between PAH group and non-PAH group in C-reactive protein-positive rate, N-terminal pro-brain natriuretic peptide (NT-proBNP), hemoglobin, prealbumin and serum albumin levels (all p < 0.05). Compared with non-PAH group, PAH group showed significant increases in right ventricular internal diameter (RVID), right ventricular outflow tract diameter (RVOTD), main pulmonary artery diameter, left atrial diameter (LAD), left ventricular end-diastolic diameter, interventricular septal thickness, left ventricular mass index, early diastolic mitral annulus velocity and valve calcification incidence (all p < 0.05), and decreased left ventricular ejection fraction (LVEF), tricuspid annulus plane systolic excursion (TAPSE) and early diastolic blood flow peak and mitral annulus velocity (E/E') (all p < 0.05). Logistic regression analysis revealed that DBP, NT-proBNP, LAD, RVID, RVOTD, LVEF, TAPSE and E/E' are major risk factors for PAH. CONCLUSION We observed a high incidence of PAH in ESRD patients undergoing CAPD. Logistic regression analysis revealed that DBP, NT-proBNP, LAD, RVID, RVOTD, LVEF, TAPSE and E/E' are high-risk factors for PAH in ESRD patients undergoing CAPD.
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Affiliation(s)
- Lei Zhang
- a Department of Nephrology , People's Hospital of Linyi, Linyi, China, People's Hospital of Linyi , Linyi , China
| | - Shiqi Zhao
- a Department of Nephrology , People's Hospital of Linyi, Linyi, China, People's Hospital of Linyi , Linyi , China
| | - Jinling Ma
- a Department of Nephrology , People's Hospital of Linyi, Linyi, China, People's Hospital of Linyi , Linyi , China
| | | | - Guizhen Qiu
- c Department of Endocrinology , People's Hospital of Linyi , Linyi , China , and
| | - Yueqin Ren
- a Department of Nephrology , People's Hospital of Linyi, Linyi, China, People's Hospital of Linyi , Linyi , China
| | - Ying Zen
- d Department of Nephrology , The Second Affiliated Hospital of Soochow University , Suzhou , China
| | - Yongbing Shi
- d Department of Nephrology , The Second Affiliated Hospital of Soochow University , Suzhou , China
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Yılmaz S, Yildirim Y, Taylan M, Demir M, Yilmaz Z, Kara AV, Aydin F, Sen HS, Karabulut A, Topcu F. The Relationship of Fluid Overload as Assessed by Bioelectrical Impedance Analysis with Pulmonary Arterial Hypertension in Hemodialysis Patients. Med Sci Monit 2016; 22:488-94. [PMID: 26874785 PMCID: PMC4755666 DOI: 10.12659/msm.896305] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Pulmonary arterial hypertension (PAH) is common disease among hemodialysis (HD) patients and is associated with increased morbidity and mortality. However, its pathogenesis has not been completely elucidated. We aimed to evaluate the frequency of PAH in HD patients, as well as the relationship between fluid status and PAH. Material/Methods We enrolled 77 HD patients in this study. Multifrequency bioimpedance analysis (BIA) was used to assess fluid status. BIA was performed before and 30 min after the midweek of HD. Overhydration (OH)/extracellular water (ECW)% ratio was used as an indicator of fluid status. Fluid overload was defined as OH/ECW ≥7%. Echocardiographic examinations were performed before and after the HD. Pulmonary arterial hypertension was defined as systolic pulmonary artery pressure at rest (sPAP) higher than 35 mmHg. Results PAH was found in 33.7% of the HD patients. OH/ECW and the frequency of fluid overload were significantly higher in HD patients with PAH than those without PAH, whereas serum albumin and hemoglobin levels were significantly lower. sPAP level was significantly higher in HD patients with fluid overload than in those without fluid overload after hemodialysis session. Furthermore, sPAP, OH/ECW levels, and the frequency of PAH were significantly reduced after HD. We also found a significant positive correlation between sPAP and OH/ECW. Multivariate logistic regression analysis demonstrated fluid overload to be an independent predictor of PAH after HD. Conclusions PAH is prevalent among HD patients. This study demonstrated a strong relationship between fluid overload and PAH in HD patients.
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Affiliation(s)
- Süreyya Yılmaz
- Department of Chest Diseases and Tuberculosis, Dicle University, Faculty of Medicine, Diyarbakir, Turkey
| | - Yasar Yildirim
- Department of Nephrology, Dicle University, Faculty of Medicine, Diyarbakir, Turkey
| | - Mahsuk Taylan
- Department of Chest Diseases and Tuberculosis, Dicle University, Faculty of Medicine, Diyarbakir, Turkey
| | - Melike Demir
- Department of Chest Diseases and Tuberculosis, Dicle University, Faculty of Medicine, Diyarbakir, Turkey
| | - Zülfükar Yilmaz
- Department of Nephrology, Dicle University, Faculty of Medicine, Diyarbakir, Turkey
| | - Ali Veysel Kara
- Department of Nephrology, Dicle University, Faculty of Medicine, Diyarbakir, Turkey
| | - Fatma Aydin
- Department of Internal Medicine, Dicle University, Faculty of Medicine, Diyarbakir, Turkey
| | - Hadice Selimoglu Sen
- Department of Chest Diseases and Tuberculosis, Dicle University, Faculty of Medicine, Diyarbakir, Turkey
| | - Aziz Karabulut
- Department of Cardiology, Dicle University, Faculty of Medicine, Diyarbakir, Turkey
| | - Fusun Topcu
- Department of Chest Diseases and Tuberculosis, Dicle University, Faculty of Medicine, Diyarbakir, Turkey
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He Y, Wang Y, Luo X, Ke J, Du Y, Li M. Risk factors for pulmonary hypertension in maintenance hemodialysis patients: a cross-sectional study. Int Urol Nephrol 2015; 47:1889-97. [DOI: 10.1007/s11255-015-1119-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 09/19/2015] [Indexed: 11/30/2022]
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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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24
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Krishnan U, Mark TM, Niesvizky R, Sobol I. Pulmonary hypertension complicating multiple myeloma. Pulm Circ 2015; 5:590-7. [PMID: 26401262 PMCID: PMC4556512 DOI: 10.1086/682430] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 04/08/2015] [Indexed: 12/15/2022] Open
Abstract
Pulmonary hypertension (PH) is an infrequently reported complication of multiple myeloma (MM). PH has been more commonly associated with amyloidosis, myeloproliferative diseases, and the POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, skin changes) syndrome. PH in MM is typically mild to moderate and may be secondary to a variety of conditions, which include left ventricular dysfunction, high-output cardiac failure, chronic kidney disease, treatment-related toxicities, and precapillary involvement. We describe 3 patients with MM and severe PH. Each patient underwent right heart catheterization. All patients demonstrated elevated pulmonary pressures, transpulmonary gradients, and pulmonary vascular resistance. Each patient was ultimately treated with pulmonary vasodilator therapy with improvement in cardiopulmonary symptoms. Additional studies are needed to define the prevalence, prognosis, and pathogenesis of PH in this complex population and to help clarify who may benefit from targeted PH therapy.
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Affiliation(s)
- Udhay Krishnan
- Division of Cardiology, Weil Cornell Medical College, New York Presbyterian Hospital-Cornell Medical Center, New York, New York, USA
| | - Tomer M. Mark
- Division of Hematology and Medical Oncology, Weil Cornell Medical College, New York Presbyterian Hospital-Cornell Medical Center, New York, New York, USA
| | - Ruben Niesvizky
- Division of Hematology and Medical Oncology, Weil Cornell Medical College, New York Presbyterian Hospital-Cornell Medical Center, New York, New York, USA
| | - Irina Sobol
- Division of Cardiology, Weil Cornell Medical College, New York Presbyterian Hospital-Cornell Medical Center, New York, New York, USA
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25
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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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26
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Mukhtar KN, Mohkumuddin S, Mahmood SN. Frequency of pulmonary hypertension in hemodialysis patients. Pak J Med Sci 2015; 30:1319-22. [PMID: 25674131 PMCID: PMC4320723 DOI: 10.12669/pjms.306.5525] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 09/05/2014] [Accepted: 09/08/2014] [Indexed: 11/29/2022] Open
Abstract
Objective: Pulmonary hypertension (PH) has been described in hemodialysis (HD) patients and has been associated with increased morbidity and mortality. Our objective was to determine the prevalence of pulmonary hypertension in patients on regular hemodialysis. Methods: This cross sectional study was conducted in Department of Nephrology, Liaquat National Hospital Karachi from April 2013 to March 2014. Eighty patients of end stage renal disease (ESRD), on maintenance hemodialysis (HD); underwent Trans thoracic Echocardiography were selected. Systolic pulmonary arterial pressure (SPAP) was recorded. Pulmonary hypertension was defined as, pulmonary artery pressure (PAP) greater than 30 mm Hg at rest. Pulmonary hypertension was further divided into mild (PAP b/w 30-45mmHg), moderate (PAP b/w 45-65mmHg) and severe pulmonary hypertension (PAP > 65mmHg). The effect of different vascular accesses, age, gender, dialysis vintage on the development of pulmonary hypertension was observed. Results: Out of 80 patients, 45 patients (56%) had pulmonary hypertension (PH); 25(55.5%) had moderate, 13(29%) had mild, and 7 (15.5%) patients had severe pulmonary hypertension (PH). Pulmonary hypertension was present in 41(60%) patients with AVF, 3(27%) patients with tunnel cuffed catheter and 1 patient had AV bridge graft. Pulmonary hypertension was more common in females; present in 28 females (67%) and 17 males (45%), that was statistically significant (p<0.05). Mean duration of hemodialysis in (months) of patients with PH was 20.93 ± 12 vs. 10.29 ±10 in patients without PH (p<0.05). Age had no relation to development of PH. Conclusion: ESRD patients on HD have strong tendency to develop PH. Our study demonstrated that PH is more common among females. Duration of hemodialysis and AV access has strong relation to the development of PH.
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Affiliation(s)
- Kunwer Naveed Mukhtar
- Dr. Kunwer Naveed Mukhtar, MD, DABN, Associate Professor, Head Department of Nephrology & Transplantation, Liaquat National Hospital & Medical College, Karachi, Pakistan
| | - Syed Mohkumuddin
- Dr. Syed Mohkumuddin, MBBS, FCPS, Consultant Nephrologist, Department of Nephrology, Sandamen Provincial Hospital Quetta, Pakistan
| | - Sumbal Nasir Mahmood
- Dr. Sumbal Nasir Mahmood, MD, DABN, Associate Professor, Department of Nephrology, Dr. Ziauddin Hospital & Medical College, Karachi, Pakistan
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27
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Elsayed ME, Stack AG. What are the Consequences of Volume Expansion in Chronic Dialysis Patients? Semin Dial 2015; 28:235-9. [DOI: 10.1111/sdi.12351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Mohamed E. Elsayed
- Departments of Nephrology and Internal Medicine; University Hospital Limerick; Limerick Ireland
- Graduate Entry Medical School; University of Limerick; Limerick Ireland
| | - Austin G. Stack
- Departments of Nephrology and Internal Medicine; University Hospital Limerick; Limerick Ireland
- Graduate Entry Medical School; University of Limerick; Limerick Ireland
- Health Research Institute; University of Limerick; Limerick Ireland
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28
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Li Z, Liang X, Liu S, Ye Z, Chen Y, Wang W, Li R, Xu L, Feng Z, Shi W. Pulmonary hypertension: epidemiology in different CKD stages and its association with cardiovascular morbidity. PLoS One 2014; 9:e114392. [PMID: 25525807 PMCID: PMC4272275 DOI: 10.1371/journal.pone.0114392] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 11/08/2014] [Indexed: 01/13/2023] Open
Abstract
Background Pulmonary hypertension (PH) was recently recognized as a common complication of end-stage renal disease (ESRD) that causes an increased risk of mortality. Epidemiological data for this disorder in earlier stages of chronic kidney disease (CKD) and its association with cardiovascular (CV) morbidity are scarce. Methods We retrospectively analyzed 2,351 Chinese CKD patients with complete clinical records and echocardiography data between Jan 2008 and May 2012. The patients were divided into the following 6 groups: CKD Stages 1–4; Stage 5 for those not on or initiated on hemodialysis for <3 months; and Stage 5D for the patients undergoing hemodialysis for ≥3 months. The prevalence of PH and CV morbidity was investigated, and their association was evaluated with a logistic regression model. Results PH was detected in 426 patients (18.1%). Mild, moderate and severe PH was diagnosed in 12.1%, 4.9% and 1.1% of the patients, respectively. Severe PH was detected in CKD Stages 5 and 5D. CV morbidity was found in 645 patients (27.4%). Compared with the non-PH group, the PH group had a higher risk for cardiac disease but not for cerebrovascular disease risk. PH severity was associated with cardiac morbidity risk [odds ratio (95% CI) for mild PH: 1.79 (1.30–2.47); moderate PH: 2.75 (1.73–4.37); severe PH: 3.90 (1.46–10.42)]. Conclusions Our study showed for the first time the epidemiology profile of PH across the spectrum of CKD. Mild-to-moderate PH occurs with more frequency in advanced CKD, and severe PH is scarce in non-ESRD CKD. PH in CKD is associated with cardiac but not cerebrovascular disease, with increasing cardiac morbidity seen with increasing PH severity. Evidence from prospective studies addressing PH in this population is needed to predict cardiac events.
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Affiliation(s)
- Zhilian Li
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Southern Medical University, Guangzhou, China
| | - Xinling Liang
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Southern Medical University, Guangzhou, China
| | | | - Zhiming Ye
- Southern Medical University, Guangzhou, China
| | | | | | - Ruizhao Li
- Southern Medical University, Guangzhou, China
| | - Lixia Xu
- Southern Medical University, Guangzhou, China
| | | | - Wei Shi
- Southern Medical University, Guangzhou, China
- * E-mail:
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29
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Alhamad EH, Al-Ghonaim M, Alfaleh HF, Cal JP, Said N. Pulmonary hypertension in end-stage renal disease and post renal transplantation patients. J Thorac Dis 2014; 6:606-16. [PMID: 24976981 DOI: 10.3978/j.issn.2072-1439.2014.04.29] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 04/15/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND Information regarding lung function parameters and functional capacity in renal failure and post renal transplantation patients with pulmonary hypertension (PH) is limited. The purpose of this study was to examine the clinical characteristics of patients with PH who were receiving hemodialysis (HD) or peritoneal dialysis (PD) or who had undergone renal transplantation. METHODS A prospective study was performed on 116 patients (HD =55, PD =17, and post renal transplantation =44) who underwent Doppler echocardiography. PH was defined as systolic pulmonary artery pressure (SPAP) ≥40 mmHg. Demographic information, clinical characteristics, pulmonary function tests (PFTs) and the six-minute walk test (6MWT) were collected and compared between the patients with and without PH. RESULTS Twelve (21.8%) patients receiving HD, four (23.5%) patients receiving PD, and eight (18.2%) post renal transplantation patients had PH. In the HD group, the physiological indicators (including pulmonary function test parameters, the final Borg score, and walking distance during the 6MWT) were all significantly lower in the patients with PH compared with those without PH (all P<0.0001). However, in the PD and post renal transplantation groups, no significant differences were noted in the demographic characteristics or in the physiological parameters when the PH patients were compared with those without PH (all P>0.05). CONCLUSIONS Among HD patients, marked aberrations in PFT results or walking distance may identify a subset of patients suffering from PH.
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Affiliation(s)
- Esam H Alhamad
- 1 Department of Medicine, College of Medicine, 2 Prince Salman bin Abdulaziz Research Chair for Kidney Disease, 3 Department of Cardiac sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia ; 4 Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada
| | - Mohammed Al-Ghonaim
- 1 Department of Medicine, College of Medicine, 2 Prince Salman bin Abdulaziz Research Chair for Kidney Disease, 3 Department of Cardiac sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia ; 4 Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada
| | - Hussam F Alfaleh
- 1 Department of Medicine, College of Medicine, 2 Prince Salman bin Abdulaziz Research Chair for Kidney Disease, 3 Department of Cardiac sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia ; 4 Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada
| | - Joseph P Cal
- 1 Department of Medicine, College of Medicine, 2 Prince Salman bin Abdulaziz Research Chair for Kidney Disease, 3 Department of Cardiac sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia ; 4 Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada
| | - Nazmi Said
- 1 Department of Medicine, College of Medicine, 2 Prince Salman bin Abdulaziz Research Chair for Kidney Disease, 3 Department of Cardiac sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia ; 4 Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada
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30
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Abstract
World Health Organization (WHO) group 5 pulmonary hypertension (PH) entails a heterogeneous group of disorders that may cause PH by unclear and/or multiple mechanisms. In particular, group 5 includes PH caused by hematologic disorders, systemic diseases, metabolic disorders, chronic renal failure, and disorders leading to pulmonary vascular occlusion or compression. This article discusses common pathogenic mechanisms leading to group 5 PH, followed by a detailed overview of epidemiology, pathogenesis, and disease-specific management of the individual group 5 conditions. Off-label use of vasomodulatory therapies, typically indicated for pulmonary arterial hypertension (WHO group 1 PH), in group 5 conditions is also discussed.
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Affiliation(s)
- Tim Lahm
- Division of Pulmonary, Allergy, Critical Care, Occupational and Sleep Medicine, Department of Medicine, Richard L. Roudebush VA Medical Center, Center for Immunobiology, Indiana University School of Medicine, 980 West Walnut Street, Room C400, Indianapolis, IN 46202, USA.
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31
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Emara MM, Habeb MA, Alnahal AA, Elshazly TA, Alatawi FO, Masoud AS. Prevalence of pulmonary hypertension in patients with chronic kidney disease on and without dialysis. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2013. [DOI: 10.1016/j.ejcdt.2013.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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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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33
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Agarwal R. Prevalence, determinants and prognosis of pulmonary hypertension among hemodialysis patients. Nephrol Dial Transplant 2012; 27:3908-14. [PMID: 22290987 DOI: 10.1093/ndt/gfr661] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The prevalence, determinants and prognosis of pulmonary hypertension among long-term hemodialysis patients in the USA are poorly understood. METHODS A cross-sectional survey of prevalence and determinants of pulmonary hypertension was performed, followed by longitudinal follow-up for all-cause mortality. Pulmonary hypertension was defined as an estimated systolic pulmonary artery pressure of >35 mmHg using echocardiograms performed within an hour after the end of dialysis. RESULTS Prevalent in 110/288 patients (38%), the independent determinants of pulmonary hypertension were the following: left atrial diameter (odds ratio 10.1 per cm/m(2), P < 0.0001), urea reduction ratio (odds ratio 0.94 per %, P < 0.01) and vitamin D receptor activator use (odds ratio 0.41 for users, P < 0.01). Over a median follow-up of 2.15 years, 97 (34%) patients died yielding a crude mortality rate (CMR) of 114.2 per 1000 patient-years. Of these, 58 deaths occurred among 110 patients with pulmonary hypertension (53%, CMR 168.9/1000 patient-years) and 39 among 178 without pulmonary hypertension (22%, CMR 52.5/1000 patient-years) [unadjusted hazard ratio (HR) for death 2.12 (95% confidence interval 1.41-3.19), P < 0.001]. After multivariate adjustment, pulmonary hypertension remained an independent predictor for all-cause mortality [HR 2.17 (95% confidence interval 1.31-3.61), P < 0.01]. CONCLUSIONS Among hemodialysis patients, pulmonary hypertension is common and is strongly associated with an enlarged left atrium and poor long-term survival. Reducing left atrial size such as through volume control may be an attractive target to improve pulmonary hypertension. Improving pulmonary hypertension in this group of patients may improve the dismal outcomes.
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Affiliation(s)
- Rajiv Agarwal
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
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Sofia M, Stanziola AA. Kidney pulmonary hypertension: another road on the map? Multidiscip Respir Med 2011; 6:150-2. [PMID: 22959065 PMCID: PMC3463072 DOI: 10.1186/2049-6958-6-3-150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 04/30/2011] [Indexed: 12/13/2022] Open
Affiliation(s)
- Matteo Sofia
- Department of Respiratory Diseases, Monaldi Hospital, University Federico II, Naples, Italy.
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