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Lentine KL, Levine DJ, Runo JR, Caliskan Y, Costa S, Lam NN, Axelrod DA, Woodside KJ. Complexities and outcomes of pulmonary hypertension in kidney transplant patients: a comprehensive review. TURKISH JOURNAL OF NEPHROLOGY 2024; 33:8-26. [PMID: 38213512 PMCID: PMC10783548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Pulmonary hypertension (PH) is often present in patients presenting for kidney transplant listing. While PH can complicate kidney transplant (KTx), with multidisciplinary management that includes both the transplant center and pulmonary hypertension center or experts both pre- and post-transplant. This review summaries the approach and management of PH in KTx candidates and recipients, along with expected outcomes and controversies surrounding arteriovenous fistula and graft management.
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Wu H, Huan C, Hu Y, Xiao S, Xu T, Guo M, Wang X, Liu A, Sun J, Wang C, Wang J, Zhu H, Pan D. Development and Validation of a Nomogram for Predicting All-Cause Mortality in Patients with Hemodialysis Having Pulmonary Hypertension. Cardiorenal Med 2023; 13:282-291. [PMID: 37640012 PMCID: PMC10664330 DOI: 10.1159/000533674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION Patients with end-stage renal disease receiving hemodialysis (HD) have a high morbidity and mortality rate associated with pulmonary hypertension (PH). A nomogram was developed to predict all-cause mortality in HD patients with PH. In this study, we aimed to validate the usefulness of this nomogram. METHODS A total of 274 HD patients with PH were hospitalized at the Affiliated Hospital of Xuzhou Medical University between January 2014 and June 2019 and followed up for 3 years. Echocardiography detected PH when the peak tricuspid regurgitation velocity (TRV) was more than 2.8 m/s. To evaluate the all-cause mortality for long-term HD patients with PH, Cox regression analysis was performed to determine the factors of mortality that were included in the prediction model. Next, the area under the receiver-operating characteristic curve (AUC-ROC) was used to assess the predictive power of the model. Calibration plots and decision curve analysis (DCA) were used to assess the accuracy of the prediction results and the clinical utility of the model. RESULTS The all-cause mortality rate was 29.20% throughout the follow-up period. The nomogram comprised six commonly available predictors: age, diabetes mellitus, cardiovascular disease, hemoglobin, left ventricular ejection fraction, and TRV. The 1-year, 2-year, and 3-year AUC-ROC values were 0.842, 0.800, and 0.781, respectively. The calibration curves revealed excellent agreement with the nomogram, while the DCA demonstrated favorable clinical practicability. CONCLUSION The first developed nomogram for predicting all-cause mortality in HD patients with PH could guide clinical decision-making and intervention planning.
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Affiliation(s)
- Huimin Wu
- Department of General Practice, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China,
| | - Chunyan Huan
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yue Hu
- Department of General Practice, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shengjue Xiao
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University 87 Dingjiaqiao, Nanjing, China
| | - Tao Xu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Minjia Guo
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Xiaotong Wang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Ailin Liu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jiayi Sun
- Department of General Practice, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Chunqing Wang
- Department of General Practice, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jia Wang
- Department of Nephrology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Hong Zhu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Defeng Pan
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
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Earasi K, Mihaltses J, Kennedy JLW, Rao S, Holsten L, Mazimba S, Doyle A, Mihalek AD. Intensive ultrafiltration strategy restores kidney transplant candidacy for patients with echocardiographic evidence of pulmonary hypertension. Clin Transplant 2022; 36:e14799. [PMID: 36029145 PMCID: PMC10078392 DOI: 10.1111/ctr.14799] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/12/2022] [Accepted: 08/10/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Pulmonary hypertension (PH) is prevalent in those with end-stage kidney disease (ESKD) and poses a barrier to kidney transplant due to its association with poor outcomes. Studies examining these adverse outcomes are limited and often utilize echocardiographic measurements of pulmonary artery systolic pressure (PASP) instead of the gold standard right heart catheterization (RHC). We hypothesized that in ESKD patients deemed ineligible for kidney transplant because of an echocardiographic diagnosis of PH the predominant cause of PH is hypervolemia and is potentially reversible. METHODS We conducted a prospective study of 16 patients with ESKD who were denied transplant candidacy. Prior echocardiograms and RHCs were reviewed for confirmation of PH. Patients were admitted for daily sessions of ultrafiltration for volume removal and repeat RHCs were performed following intervention. RHC parameters and body weight were compared before and after intervention. Statistical analysis was performed using PRISM GraphPad software. A p-value <.05 was considered statistically significant. RESULTS Following intervention, the mean pulmonary artery pressure (mPAP) and pulmonary arterial wedge pressure decreased from 45.0 ± 3.06 to 29.1 ± 7.77 mmHg (p < .0001) and 22.2 ± 5.06 to 13.1 ± 7.25 mmHg (p = .003), respectively. The pulmonary vascular resistance decreased from 4.73 ± 1.99 to 4.28 ± 2.07 WU (p = .30). Eleven patients from the initial cohort underwent successful kidney transplantation post-intervention with 100% survival at 1-year. CONCLUSIONS In ESKD patients, diagnoses of PH made by echocardiography may be largely due to hypervolemia and may be optimized using an intensive ultrafiltration strategy to restore transplant candidacy.
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Affiliation(s)
- Kranthikiran Earasi
- Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - John Mihaltses
- Eastern Nephrology Associates, Wilmington, North Carolina, USA
| | | | - Swati Rao
- Department of Medicine, University of Virginia, Charlottesville, Virginia, USA.,Division of Nephrology, University of Virginia, Charlottesville, Virginia, USA
| | - Laura Holsten
- Department of Medicine, University of Virginia, Charlottesville, Virginia, USA.,Division of Nephrology, University of Virginia, Charlottesville, Virginia, USA
| | - Sula Mazimba
- Department of Medicine, University of Virginia, Charlottesville, Virginia, USA.,Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Alden Doyle
- Department of Medicine, University of Virginia, Charlottesville, Virginia, USA.,Division of Nephrology, University of Virginia, Charlottesville, Virginia, USA
| | - Andrew D Mihalek
- Department of Medicine, University of Virginia, Charlottesville, Virginia, USA.,Division of Pulmonary and Critical Care Medicine, University of Virginia, Charlottesville, Virginia, USA
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Brinza C, Covic A, Stefan AE, Floria M, Popa IV, Scripcariu DV, Burlacu A. Pulmonary Arterial Hypertension and Adverse Outcomes after Kidney Transplantation: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:1944. [PMID: 35407552 PMCID: PMC8999673 DOI: 10.3390/jcm11071944] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/18/2022] [Accepted: 03/28/2022] [Indexed: 12/10/2022] Open
Abstract
Pulmonary arterial hypertension (PH) has a high prevalence in chronic kidney disease (CKD) patients, especially those undergoing kidney transplantation (KT). We aimed to systematically review and calculate the pooled effect size of the literature evaluating the association between pre-existing PH documented by transthoracic echocardiography (TTE) or invasively and adverse outcomes following KT. The primary composite outcome extracted from the included studies was represented by the mortality from any cause following KT and delayed graft function (DGF), graft dysfunction, or graft failure. The secondary outcomes were represented by individual components of the primary composite outcome. Twelve studies meeting the inclusion criteria were selected. The main finding is that pre-existing PH was associated with increased mortality and a higher rate of DGF, kidney graft dysfunction, or failure in KT recipients. The effect remained significant for all outcomes irrespective of PH evaluation, invasively or using TTE. Consequently, patients with PH defined only by TTE were at higher risk of death, DGF, or graft failure. Our findings support the routine assessment of PH in patients on the KT waitlist. PH might represent an extensively available and valuable tool for risk stratification in KT patients. These data should be confirmed in large prospective clinical trials.
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Affiliation(s)
- Crischentian Brinza
- Institute of Cardiovascular Diseases, 700503 Iasi, Romania;
- Faculty of Medicine, University of Medicine and Pharmacy Grigore T Popa, 700115 Iasi, Romania; (A.C.); (M.F.); (I.V.P.)
| | - Adrian Covic
- Faculty of Medicine, University of Medicine and Pharmacy Grigore T Popa, 700115 Iasi, Romania; (A.C.); (M.F.); (I.V.P.)
- Nephrology Clinic, Dialysis and Renal Transplant Center—Constantin Ion Parhon University Hospital, 700503 Iasi, Romania;
| | - Anca Elena Stefan
- Nephrology Clinic, Dialysis and Renal Transplant Center—Constantin Ion Parhon University Hospital, 700503 Iasi, Romania;
| | - Mariana Floria
- Faculty of Medicine, University of Medicine and Pharmacy Grigore T Popa, 700115 Iasi, Romania; (A.C.); (M.F.); (I.V.P.)
- Doctor Iacob Czihac Military Emergency Clinical Hospital, 700483 Iasi, Romania
| | - Iolanda Valentina Popa
- Faculty of Medicine, University of Medicine and Pharmacy Grigore T Popa, 700115 Iasi, Romania; (A.C.); (M.F.); (I.V.P.)
| | - Dragos-Viorel Scripcariu
- Faculty of Medicine, University of Medicine and Pharmacy Grigore T Popa, 700115 Iasi, Romania; (A.C.); (M.F.); (I.V.P.)
| | - Alexandru Burlacu
- Institute of Cardiovascular Diseases, 700503 Iasi, Romania;
- Faculty of Medicine, University of Medicine and Pharmacy Grigore T Popa, 700115 Iasi, Romania; (A.C.); (M.F.); (I.V.P.)
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Puthenveettil N, Mohan A, Rahman S, Paul J. Pregnancy outcomes in renal transplant recipients. Indian J Anaesth 2021; 65:695-699. [PMID: 34764505 PMCID: PMC8577703 DOI: 10.4103/ija.ija_362_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/14/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Nitu Puthenveettil
- Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Anish Mohan
- Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Sajan Rahman
- Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Jerry Paul
- Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
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[Anesthesia for renal transplantation in patients with dilated cardiomyopathy: a retrospective study of 31 cases]. Rev Bras Anestesiol 2019; 69:477-483. [PMID: 31669040 DOI: 10.1016/j.bjan.2019.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 04/03/2019] [Accepted: 06/09/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Dilated cardiomyopathy is a state of progressive enlargement of cardiac chambers mainly left ventricle which leads to decreased cardiac output and ultimately cardiac failure. Although it has multifactorial etiology, it is quite common in patients with end stage renal disease who require renal transplant surgery for their cure. Both conditions go side by side and anesthetic management of such cases poses real challenge to anesthesiologist. Strict monitoring and control of cardiac physiology is of utmost importance besides meticulous fluid management, thus preserving renal blood flow on one hand and preventing cardiac failure on other hand. This is the basis of achieving good outcome of the renal transplant surgery. METHODS This is a retrospective observational study done by analysing electronic database of 31 patients with dilated cardiomyopathy who underwent renal transplant surgery. Data was studied in terms of demographics, duration of renal disease, comorbidities mainly hypertension, cardiac echo graphic findings including ejection fraction, medications and post-operative outcome. RESULTS Most common perioperative complication in this patient population was hypotension (51.61%) followed by pulmonary complications postoperative mechanical ventilation (12.9%) and pulmonary edema (6.45%). High incidence of hypotension may be a causative factor to increased rate of delayed graft functioning (12.9%) and acute tubular necrosis (2.23%) in these patients. CONCLUSION Strict monitoring and control of hemodynamic parameters as well as meticulous fluid therapy is the cornerstone in improving outcome in patients with dilated cardiomyopathy undergoing renal transplant surgery.
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Goyal VK, Gupta P, Baj B. Anesthesia for renal transplantation in patients with dilated cardiomyopathy: a retrospective study of 31 cases. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2019. [PMID: 31669040 PMCID: PMC9391908 DOI: 10.1016/j.bjane.2019.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Solanki SL, Goyal VK, Baj B. Reply to 'The link between pulmonary hypertension and adverse renal transplant outcome may be renal venous hypertension'. Indian J Anaesth 2018; 62:325. [PMID: 29720766 PMCID: PMC5907446 DOI: 10.4103/ija.ija_179_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Sohan Lal Solanki
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
- Address for correspondence: Dr. Sohan Lal Solanki, Department of Anaesthesiology, Critical Care and Pain, 2nd Floor, Main Building, Tata Memorial Hospital, Parel, Mumbai-400012, India. E-mail:
| | - Vipin Kumar Goyal
- Department of Anaesthesiology and Critical Care, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Birbal Baj
- Department of Anaesthesiology and Critical Care, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
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