Lung congestion as a hidden threat in end-stage kidney disease: a call to action

Zoccali, Carmine; Puntorieri, Elvira; Mallamaci, Francesca

doi:10.1093/ndt/gft425

Cited by 12 publications

(7 citation statements)

References 28 publications

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“…77 In the long-term, exposure of RV to elevated pulmonary pressure may result in compensatory RV hypertrophy, which deteriorates LV filling capacity via interventricular interaction, leading to further LV diastolic dysfunction. 76 A high pulmonary capillary wedge pressure in patients receiving dialysis almost always results from a combination of volume overload and LV dysfunction, 78 and pulmonary hypertension represents a strong and independent predictor of cardiovascular events and mortality in hemodialysis. 79 Observations that frequent dialysis is associated with LVH reduction 2,64 support the above notions.…”

Section: Pathophysiologic Considerations For Intra-and Interdialytic mentioning

confidence: 99%

The Ebb and Flow of Echocardiographic Cardiac Function Parameters in Relationship to Hemodialysis Treatment in Patients with ESRD

Loutradis¹,

Sarafidis²,

Papadopoulos

et al. 2018

JASN

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Cardiovascular disease is the leading cause of mortality in patients receiving hemodialysis. Cardiovascular events in these patients demonstrate a day-of-week pattern; they occur more commonly during the last day of the long interdialytic interval and the first session of the week. The hemodialysis process causes acute decreases in cardiac chamber size and pulmonary circulation loading and acute diastolic dysfunction, possibly through myocardial stunning and other non-myocardial-related mechanisms; systolic function, in contrast, is largely unchanged. During interdialytic intervals volume overload, acid-base, and electrolyte shifts, as well as arterial and myocardial wall changes, result in dilatation of right cardiac chambers and pulmonary circulation overload. Recent studies suggest that these alterations are more extended during the long interdialytic interval or the first dialysis session of the week and are associated with excess volume overload or removal, respectively, thus adding a mechanism for the day-of-week pattern of mortality in patients receiving hemodialysis. This review summarizes the existing data from echocardiographic studies of cardiac morphology and function during the hemodialysis session, as well as during the interdialytic intervals.

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Section: Pathophysiologic Considerations For Intra-and Interdialytic mentioning

confidence: 99%

The Ebb and Flow of Echocardiographic Cardiac Function Parameters in Relationship to Hemodialysis Treatment in Patients with ESRD

Loutradis¹,

Sarafidis²,

Papadopoulos

et al. 2018

JASN

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“…In a recent subproject of the ongoing Lung Water by Ultra-Sound Guided Treatment to Prevent Death and Cardiovascular Complications in High Risk ESRD Patients with Cardiomyopathy (LUST) trial, both pedal edema and crackles in lung auscultation of hemodialysis patients reflected very poorly the degree of pulmonary congestion objectively assessed by lung ultrasound [135]. Bioimpedance methods and relative blood volume monitoring are increasingly used to assess whole body fluid status in dialysis patients [136]; a combination of these methods with lung ultrasound may provide a more precise estimate of fluid accumulation in critical organs and, thus, help towards objective definition of dry-weight [137]. Previous uncontrolled observations in small series of patients [138][139][140] suggested that supervised gradual reduction (probing) of dry-weight can effectively reduce BP.…”

Section: Achievement Of Patient's Dry-weightmentioning

confidence: 99%

Hypertension in dialysis patients

Sarafidis

Persu

Agarwal

et al. 2017

Journal of Hypertension

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In patients with end-stage renal disease treated with hemodialysis or peritoneal dialysis, hypertension is very common and often poorly controlled. Blood pressure (BP) recordings obtained before or after hemodialysis display a J-shaped or U-shaped association with cardiovascular events and survival, but this most likely reflects the low accuracy of these measurements and the peculiar hemodynamic setting related with dialysis treatment. Elevated BP by home or ambulatory BP monitoring is clearly associated with shorter survival. Sodium and volume excess is the prominent mechanism of hypertension in dialysis patients, but other pathways, such as arterial stiffness, activation of the renin-angiotensin-aldosterone and sympathetic nervous systems, endothelial dysfunction, sleep apnea and the use of erythropoietin-stimulating agents may also be involved. Nonpharmacologic interventions targeting sodium and volume excess are fundamental for hypertension control in this population. If BP remains elevated after appropriate treatment of sodium-volume excess, the use of antihypertensive agents is necessary. Drug treatment in the dialysis population should take into consideration the patient's comorbidities and specific characteristics of each agent, such as dialysability. This document is an overview of the diagnosis, epidemiology, pathogenesis and treatment of hypertension in patients on dialysis, aiming to offer the renal physician practical recommendations based on current knowledge and expert opinion and to highlight areas for future research.

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“…Most haemodialysis patients gain fluid between dialysis sessions [10], and this increase in extracellular volume includes lung water. As such, lung water content is increased even in healthy haemodialysis outpatients without any respiratory symptoms prior to dialysis [11]. Whereas it was readily established that the mouth and upper airway are extensively colonized by bacteria, it is only relatively recently that it has been recognized that the lung is also normally colonized.…”

mentioning

confidence: 99%

Reducing the risk of infection in end-stage kidney failure patients treated by dialysis

Collier

Davenport

2014

Nephrology Dialysis Transplantation

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Lung congestion as a hidden threat in end-stage kidney disease: a call to action

Cited by 12 publications

References 28 publications

The Ebb and Flow of Echocardiographic Cardiac Function Parameters in Relationship to Hemodialysis Treatment in Patients with ESRD

The Ebb and Flow of Echocardiographic Cardiac Function Parameters in Relationship to Hemodialysis Treatment in Patients with ESRD

Hypertension in dialysis patients

Reducing the risk of infection in end-stage kidney failure patients treated by dialysis

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