Diastolic Dysfunction, an Underestimated New Challenge in Dialysis

Escoli, Rachele; Carvalho, Maria João; Cabrita, António; Rodrigues, Anabela

doi:10.1111/1744-9987.12756

Cited by 23 publications

(15 citation statements)

References 65 publications

(88 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“… 9 , 10 Hemodynamic factors that cause impaired diastolic function in CKD comprise increased preload due to volume overload and anaemia, and increased afterload mediated by heightened peripheral resistance and marked arteriosclerosis that results in arterial stiffness and enhanced wave reflection and pressure pulsatility. 3 , 11 Other reported determinants of impaired diastolic function in CKD patients encompass aberrant bone mineral metabolism including secondary hyperparathyroidism, inflammation and oxidative stress. 3 , 11 …”

Section: Introductionmentioning

confidence: 99%

“… 3 , 11 Other reported determinants of impaired diastolic function in CKD patients encompass aberrant bone mineral metabolism including secondary hyperparathyroidism, inflammation and oxidative stress. 3 , 11 …”

Section: Introductionmentioning

confidence: 99%

“…In this regard, anaemia not only increases cardiac preload and left ventricular mass but can also cause tissue hypoxia with consequent myocardial fibrosis. 16–20 Secondary hyperparathyroidism can increase cardiac afterload through enhancing arteriosclerosis 1 , 11 and directly induce cardiac hypertrophy and myocardial fibrosis. 21 …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Association of Post Transplantation Anaemia and Persistent Secondary Hyperparathyroidism with Diastolic Function in Stable Kidney Transplant Recipients

Hsu¹,

Norton²,

Peters³

et al. 2021

IJNRD

View full text Add to dashboard Cite

Introduction We hypothesized that post transplantation anaemia and persistent secondary hyperparathyroidism are potential determinants of diastolic function in stable kidney transplant recipients. Methods We assessed traditional and non-traditional cardiovascular risk factors and determined carotid artery intima-media thickness and plaque by ultrasound, arterial function by applanation tonometry using SphygmoCor software and diastolic function by echocardiography in 43 kidney transplant recipients with a transplant duration of ≥6 months, no acute rejection and a glomerular filtration rate of ≥15 mL/min/1.73m 2 . Results Mean (SD; range) transplant duration was 12.3 (8.0; 0.5–33.8) years. Post transplantation anaemia and persistent secondary hyperparathyroidism were identified in 27.9% and 30.8% of the patients, respectively; 67.5% of the participants were overweight or obese. In established confounder adjusted analysis, haemoglobin (partial R =−0.394, p=0.01) and parathyroid hormone concentrations (partial R =0.382, p=0.02) were associated with E/e’. In multivariable analysis, haemoglobin (partial R =−0.278, p=0.01) and parathyroid levels (partial R =0.324, p=0.04) were independently associated with E/e’. Waist–height ratio (partial R =−0.526, p=0.001 and partial R =−0.355, p=0.03), waist circumference (partial R =−0.433, p=0.008 and partial R =−0.393, p=0.02) and body mass index (partial R =−0.332, p=0.04 and partial R =−0.489, p=0.002) were associated with both e’ and E/A, respectively, in established confounder adjusted analysis. The haemoglobin-E/e’ (partial R =−0.422, p=0.02), parathyroid hormone-E/e’ (partial R =0.434, p=0.03), waist–height ratio-e’ (partial R =−0.497, p=0.007) and body mass index-E/A (partial R =−0.386, p=0.04) relationships remained consistent after additional adjustment for left ventricular mass index and cardiac preload and afterload measures. Conclusion Haemoglobin and parathyroid hormone concentrations as well as adiposity measures are independently associated with diastolic function in kidney transplant recipients. Whether adequate management of post transplantation anaemia, persistent secondary hyperparathyroidism and excess adiposity can prevent the development of heart failure with preserved ejection fraction in kidney transplant recipients merits further investigation.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Association of Post Transplantation Anaemia and Persistent Secondary Hyperparathyroidism with Diastolic Function in Stable Kidney Transplant Recipients

Hsu¹,

Norton²,

Peters³

et al. 2021

IJNRD

View full text Add to dashboard Cite

show abstract

“…The risk factors and their involvement in the pathophysiology of diastolic dysfunction in HD patient populations are complex. In addition to traditional risk factors, such as older age, diabetes, and higher blood pressure, certain uremia-related predisposing factors, such as oxidative stress, malnutrition, inflammation, and uremic toxins, have also been shown to contribute to abnormal myocardial relaxation and ventricular stiffness [ 16 , 26 ]. As this condition progresses, cardiac remodeling and fibrosis lead to increased LV filling pressure and diastolic dysfunction [ 5 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…Up to 40–78% of patients undergoing HD have been reported to have a zinc deficiency [ 14 , 15 ]. The effects of pharmacological strategies targeting diastolic dysfunction in HD patients remain unsatisfactory [ 16 ]; however, accumulating evidence indicates that zinc plays a pivotal role in attenuating cardiac remodeling through the modulation of antioxidant enzymes [ 17 , 18 ]. Furthermore, a recent meta-analysis of 27 case–control studies reported significantly lower serum zinc levels in patients with heart failure than in control subjects [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

Association between Reduced Serum Zinc and Diastolic Dysfunction in Maintenance Hemodialysis Patients

Huang

et al. 2021

Nutrients

View full text Add to dashboard Cite

Diastolic dysfunction is an emerging challenge among hemodialysis (HD) patients, and the associations between serum zinc with echocardiographic parameters and diastolic function remain uncertain. A total of 185 maintenance HD patients were stratified by the tertiles of serum zinc level to compare their clinical characteristics and echocardiography. Correlations of serum zinc levels with echocardiographic parameters were examined using Pearson’s analysis. Univariate and multivariate logistic regression analyses were performed to investigate the determinants of E/e’ ratio >15 and left atrial volume index (LAVI) > 34 mL/m2, both indicators of diastolic dysfunction. Patients belonging to the first tertile of serum zinc level had a significantly higher E/e’ ratio and LAVI. Serum zinc levels were negatively correlated with E (r = −0.204, p = 0.005), E/e’ ratio (r = −0.217, p = 0.003), and LAVI (r = −0.197, p = 0.007). In a multivariate analysis, older age, diabetes, coronary artery disease, and lower serum zinc levels (OR = 0.974, 95% CI = 0.950–0.999, p = 0.039) were significantly associated with E/e’ ratio >15. Furthermore, diabetes and lower serum zinc levels (OR = 0.978, 95% CI = 0.958–0.999, p = 0.041) were significantly associated with LAVI >34 mL/m2. Reduced serum zinc level was significantly associated with diastolic dysfunction among HD patients. Further prospective studies are warranted to investigate whether zinc supplementation can attenuate cardiac dysfunction in maintenance HD patients.

show abstract

Renal and cardiovascular prognostic significance of echocardiographic early diastolic mitral annular velocity in IgA nephropathy

Sági,

Késői,

Vas

et al. 2023

Int J Cardiovasc Imaging

View full text Add to dashboard Cite

In chronic kidney disease (CKD), as in IgA nephropathy (IgAN), cardiovascular (CV) mortality and morbidity are many times higher than in the general population, and diastolic dysfunction (LVDD) has prognostic significance as well. Tissue Doppler Echocardiography (TDI) is another method for measuring myocardial contractility and determining diastolic dysfunction. 79 IgAN patients (age 46 ± 11 years) with CKD stages 1–3 were investigated and followed for 70 ± 28.7 months. Doppler echocardiography was used to measure the E (early) and A (late) waves, as well as the E wave deceleration time (EDT) during mitral inflow. TDI was used to measure early (Ea) and late (Aa) diastolic velocities (lateral and septal basal wall fragment average). From these, we calculated the E/Ea and Ea/Aa ratios. The primary combined endpoints were total mortality, major CV events, and end-stage renal disease, and the secondary endpoints were cardiovascular or renal (eGFR decreased below 15 ml/min/1.73 m2 or renal replacement therapy was started). Patients with decreased Ea (< 13 cm/s) had significantly more endpoints (20/42 vs. 3/37; p = 0.001) than patients with higher Ea (≥ 13 cm/s). The secondary renal endpoints were also significantly higher (p = 0.004). In a multivariate model, the eGFR showed independent correlation with the E/A ratio (r = 0.466; p < 0.01), EDT (r = − 0.270; p < 0.01), Ea/Aa ratio (r = 0.455; p < 0.01), and decreased Ea (r = 0.544; p < 0.01). Independent factors influencing Ea were only EDT by uni- and multivariate regression but age and albuminuria by logistic regression. Decreased Ea measured by TDI seems to be an eligible factor to predict the prognosis of IgA nephropathy. The decreased Ea may be a helpful parameter to identify high-risk CKD patients.

show abstract

Diastolic Dysfunction, an Underestimated New Challenge in Dialysis

Cited by 23 publications

References 65 publications

Association of Post Transplantation Anaemia and Persistent Secondary Hyperparathyroidism with Diastolic Function in Stable Kidney Transplant Recipients

Association of Post Transplantation Anaemia and Persistent Secondary Hyperparathyroidism with Diastolic Function in Stable Kidney Transplant Recipients

Association between Reduced Serum Zinc and Diastolic Dysfunction in Maintenance Hemodialysis Patients

Renal and cardiovascular prognostic significance of echocardiographic early diastolic mitral annular velocity in IgA nephropathy

Contact Info

Product

Resources

About