Association of overhydration and cardiac dysfunction in patients have chronic kidney disease but not yet dialysis

Yılmaz, Akar; Yılmaz, Banu Aktaş; Küçükseymen, Selçuk; Özpelit, Emre; Pekel, Nihat

doi:10.1016/j.nephro.2015.08.003

Cited by 13 publications

(13 citation statements)

References 18 publications

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“…This may be due to differences between the studied groups of patients regarding the causes of cardiac hypertrophy. Overhydration is an important factor contributing to LVH in HD patients, and fluid overload is associated with pressure-related echocardiographic parameters, such as LAVI as well as E/e`[ 34 , 35 ].Syndecan-4 plays a role in a myriad of processes that are involved in the heart failure pathogenesis[ 12 – 17 , 25 , 36 ].Results of previous studies have demonstrated that syndecan-4 is essential for development of cardiac hypertrophy [ 9 , 15 , 25 ], and syndecan-4 production is increased in the repair, but not undamaged region after myocardial infarction [ 10 ]. Weak relation between syndecan-4 and NT-proBNP may result from the fact that both biomarkers may represent somewhat different aspects of failing heart.…”

Section: Discussionmentioning

confidence: 99%

Syndecan-4 Is an Independent Predictor of All-Cause as Well as Cardiovascular Mortality in Hemodialysis Patients

et al. 2016

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BackgroundLeft ventricular hypertrophy is associated withincreased mortality in hemodialysis (HD) patients.Syndecan-4 plays a role in many processes that are involved in the heart fibrosis and hypertrophy.We designed this study to prospectively determine whether syndecan-4 was predictive of mortality in a group of HD patients.MethodsIn total, 191 HD patients were included. Clinical, biochemical and echocardiographic parameters were recorded. HD patients were followed-up for 23.18 ± 4.02 months.ResultsSyndecan-4 levels correlated strongly with geometrical echocardiographic parameters and ejection fraction. Relations with pressure-related parameters were weak and only marginally significant. Using the receiver operating characteristics the optimal cut-off points in predicting all-cause as well as cardiovascular (CV) mortality were evaluated and patients were divided into low and high syndecan-4 groups. A Kaplan–Meier analysis showed that the cumulative incidences of all-cause as well as CV mortality were higher in high serum syndecan-4 group compared with those with low serum syndecan-4 (p<0.001 in both cases).A multivariate Cox proportional hazards regression analysis revealed syndecan-4 concentration to be an independent and significant predictor of all-cause (hazard ratio, 2.99; confidence interval, 2.34 to 3.113; p<0.001)as well as CV mortality (hazard ratio, 2.81;confidence interval, 2.28to3.02; p<0.001).ConclusionsSerum syndecan-4 concentration reflects predominantly geometrical echocardiographic parameters. In HD patients serum syndecan-4 concentration is independently associated with all-cause as well as CV mortality.

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Section: Discussionmentioning

confidence: 99%

Syndecan-4 Is an Independent Predictor of All-Cause as Well as Cardiovascular Mortality in Hemodialysis Patients

et al. 2016

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“…The prevalence of volume overload during the earlier stages of CKD is unclear and its significance has not been explained. Only a limited number of studies have been conducted in CKD patients not yet on dialysis [26][27][28].…”

Section: Introductionmentioning

confidence: 99%

Is N-terminal pro-brain natriuretic peptide a reliable marker for body fluid status in children with chronic kidney disease?

Nalçacıoğlu

Özkaya

Kafalı

et al. 2020

aoms

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Introduction: Brain natriuretic peptides, released in response to left ventricular stress, have a strong prognostic value in dialysis patients. However, their role in detecting abnormalities of fluid status is under debate; the relationship between volume status and brain natriuretic peptides (BNPs) differs among various studies. The aim of our study was to evaluate the clinical utility of N-terminal proBNP in the assessment of fluid status and cardiovascular risk in this setting. Material and methods: The study included 65 children: 10 pre-dialysis, 13 hemodialysis, 12 peritoneal dialysis patients and 30 healthy controls. Volume status was determined by multifrequency bioimpedance and NTpro-BNP, as well as echocardiography to estimate the left ventricle structure and function. Results: The median log NT-proBNP values of hemodialysis and peritoneal dialysis patients were 3.66 (2.05-4.90) and 3.57 (2.51-4.13) pg/ml, respectively, and significantly higher compared with the control group (p < 0.001, p < 0.001). On simple correlation, NT-proBNP was correlated with markers of volume overload and cardiac dysfunction. On multivariate regression analysis, only left ventricle mass index (β = 0.402, p = 0.003) and left atrium diameter (β = 0.263, p = 0.018) were independently associated with NT-proBNP (adjusted R 2 of the model: 0.707, p < 0.001). Conclusions: Our research suggested that NT-proBNP, which was correlated with LV systolic and diastolic dysfunction and fluid overload as assessed by bioimpedance, can be used to evaluate cardiovascular states in a chronic kidney disease (CKD) population. From the early stages of CKD, periodic monitoring of NT-proBNP levels may be essential for early detection of patients with high risk of cardiovascular events, and for taking preventive intervention as soon as possible.

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“…Traditionally, the relation between FO and outcome has been explained by its cardiovascular effects [3], such as left ventricular hypertrophy, systolic dysfunction, pulmonary hypertension, and increased aortic stiffness [4-7], but recent evidence suggests that noncardiovascular factors are also of importance in further explaining the relation between FO and mortality [8, 9]. One important factor appears to be systemic inflammation [10-12].…”

Section: Introductionmentioning

confidence: 99%

Fluid Overload and Inflammation Axis

et al. 2018

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Extracellular fluid overload (FO), which is assessed using bioimpedance technologies, is an important predictor of outcome in dialysis patients and in patients with early stages of chronic kidney disease. While traditional cardiovascular abnormalities are assumed to mediate this risk, recently also, the importance of noncardiovascular factors, such as systemic inflammation and malnutrition has been shown. While both FO and inflammation are independent risk factors for mortality, recent studies have shown that their combined presence can lead to a cumulative risk profile. From a pathophysiologic viewpoint, FO and inflammation can also be mutually reinforcing. Inflammation could contribute to FO by hypoalbuminemia, capillary leakage, and a (unnoticed) decline in lean and/or fat tissue mass resulting in incorrect estimation of dry weight. Reciprocally, FO could lead to inflammation by the translocation of endotoxins through a congested bowel wall or by a proinflammatory effect of tissue sodium. The relative importance of these putative factors is, however, not clear yet and epidemiological studies have shown no clear temporal direction regarding the relationship between FO and inflammation. FO and inflammation appear to be part of (dynamic) clusters of risk factors, including malnutrition and hyponatremia. Technology-guided fluid management of the often vulnerable dialysis patient with FO and inflammation cannot yet be based on evidence from randomized controlled trials, in which these specific patients were in general not included. In the absence of those trials, treatment should be based on identifying actionable causes of inflammation and on the judicious removal of excess volume based on frequent clinical reassessment.

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Association of overhydration and cardiac dysfunction in patients have chronic kidney disease but not yet dialysis

Cited by 13 publications

References 18 publications

Syndecan-4 Is an Independent Predictor of All-Cause as Well as Cardiovascular Mortality in Hemodialysis Patients

Syndecan-4 Is an Independent Predictor of All-Cause as Well as Cardiovascular Mortality in Hemodialysis Patients

Is N-terminal pro-brain natriuretic peptide a reliable marker for body fluid status in children with chronic kidney disease?

Fluid Overload and Inflammation Axis

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