Pulmonary Hypertension in Dialysis Patients

Domenici, Alessandro; Luciani, Remo; Principe, Francesco

doi:10.3747/pdi.2009.00082

Cited by 14 publications

(19 citation statements)

References 8 publications

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“…PH comprises a group of clinical and pathophysiological entities with similar features, but various underlying causes, including CKD (Havlucu et al, 2007;Domenici et al, 2010). The prevalence of PH ranges from 9-39% in predialysis patients with stage-5 CKD (Yigla et al, 2003;Buemi et al, 2007;Havlucu et al, 2007;Abdelwhab and Elshinnawy, 2008;Issa et al, 2008), 18.8-68.8% in hemodialysis patients, and 0-42% in individuals on peritoneal dialysis therapy (Kumbar et al, 2007;Bozbas et al, 2009;Unal et al, 2009;Casas-Aparicio et al, 2010;Kiykim et al, 2010;Fabbian et al, 2011;Agarwal, 2012;Etemadi et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

Pulmonary hypertension in patients with stage 1-3 chronic kidney disease

Yang

Bao

2014

Genet. Mol. Res.

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ABSTRACT. Pulmonary hypertension (PH) secondary to chronic kidney disease (CKD) is common, but in stages 1-3 CKD patients, it remains unclear. We sought to evaluate the prevalence of PH and elucidate the possible pathogenesis in Chinese patients with early stage kidney disease. Doppler-estimated pulmonary systolic artery pressure (PASP) was measured in 101 CKD patients with glomerular filtration rate (GFR) ≥60 mL/min/1.73 m 2 and 27 CKD patients with GFR < 60 mL/min/1.73 m 2 . Echocardiographic parameters, plasma brain natriuretic peptide (BNP), and baseline characteristics of patients were recorded. PH was defined as a PASP ≥ 35 mmHg. PH prevalence was 23.76% (24/101) in GFR ≥ 60 mL/min/1.73 m 2 group and 48.15% (13/27) in GFR < 60 mL/min/1.73 m 2 group, P < 0.05. Mean lnBNP was 4.93 ± 1.60 pg/mL in 37 cases with PH and 2.89 ± 1.29 pg/mL in those without, P < 0.01. Left atrial diameter (LA) showed deviation between patients with (43.94 ± 5.81 mm) and without PH (37.76 ± 7.48 mm), P < 0.01. GFR declined significantly in PH group (44.10 ± 22.90 mL/ min/1.73 m 2 ) compared to non-PH group (75.59 ± 31.62 mL/min/1.73 m 2 ), P < 0.01. lnBNP, LA and GFR were independent determinants (r = 0.651, 0.595, -0.488, P < 0.01) of PASP. PH is prevalent among stage 1-3 CKD patients in China. Doppler-estimated PASP is strongly associated with lnBNP, enlarged LA and GFR. Monitoring PASP, plasma BNP and evaluation renal function may help to detect and

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Section: Discussionmentioning

confidence: 99%

Pulmonary hypertension in patients with stage 1-3 chronic kidney disease

Yang

Bao

2014

Genet. Mol. Res.

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“…Так, в экспери-ментальных работах показано, что гиперпаратиреоз и дефицит витамина Д может иметь отрицательное влияние на левый желудочек (ЛЖ). Активно изуча-ется также влияние минерального обмена и на ПЖ при почечной дисфункции [33][34][35]. В частности, признаки гиперпаратиреоза, гиперфосфатемии, де-фицита витамина Д и кальцификации сосудов в ас-социации с КРС тип 4 определялись уже на ранних стадиях ХБП [13,34].…”

Section: Introductionunclassified

“…Так, исследование в округе Олмстед [50] и Эхо-КГ ис-следование Armadale [51] показали уровень ePASP около 5% в первом случае и 9,1% во втором. У паци-ентов в последние стадии ХБП -стадия С5, согласно KDOQI (Kidney Disease Outcomes Quality Initiative), уровень ePASP значительно превышает, чем среди населения в целом, составляя 9-39% среди получаю-щих консервативное лечение, 18,8-68,8% среди па-циентов, находящихся на гемодиализе [50] и 0-42% среди лиц, находящихся на перитонеальном диали-зе [33]. Легочная гипертензия при ХБП может быть связана с несколькими факторами риска, такими как анемия, апноэ, повышение симпатической активно-сти, воспаление, кальцификация сосудов и эндотели-альная дисфункция, но остается неясным патогенез легочной артериальной гипертензии (ЛАГ) на ран-них стадиях у пациентов с ХБП [13,48].…”

Section: Introductionunclassified

“…К тому же ePASP отрицательно коррелировал с СКФ, показывая его прогрессивное увеличение с ухудшением функции почек, в то же время не было никаких статистиче-ски значимых различий между двумя группами по давлению заклинивания легочной артерии и конеч-но-диастолическому объему ПЖ. На самом деле, на экспериментальных моделях (на собаках) была по-казана связь гиперпаратиреоза с кальцификацией легочных сосудов и ЛАГ, увеличением частоты ЛАГ, выявлена взаимосвязь ЛАГ и гиперпаратиреодизма у предиализных и диализных больных [33]. Недо-статочная активация рецепторов витамина Д также может влиять на КРС тип 4, который выражается в поражении не только классических органов мише-ней, но и других неклассических мишеней, включая сосуды, сердце, иммунную систему, эндокринные органы и нервную систему.…”

Section: Introductionunclassified

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Effect of Renal Dysfunction on the Cardiacvascular System. The Possibili Ties of Early Diagnosis of the Renal Dysfunction

Imanov¹,

Муркамилов²,

Сабиров³

et al. 2018

Arhivʺ vnutr. med.

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The review is devoted to the discussion of modern concepts of the role of renal dysfunction in the development of chronic myocardial dysfunction in the context of cardio-renal syndrome (RVC) type 4. At the beginning of the review, the definition of cattle is given, general questions of pathogenesis and diagnosis of the disease are addressed. It is indicated that in patients with the initial stage of CKD, cardiovascular disorders are already registered which in the late stages of development of renal dysfunction are the leading causes of death and the true severity of the disease in patients with renal dysfunction is associated with an increased risk of cardiovascular events, rather than an achievement terminal renal failure and requiring renal replacement therapy. The progression of renal pathology leads to damage to the heart through various mechanisms and factors, both traditional and non-traditional, some of which, at the culmination of the renal continuum, are the result of the dialysis procedure itself in patients with terminal renal dysfunction. Mechanisms for the development of congestive heart failure in type 4 cattle include pressure overload (arterial hypertension) and volume (anemia, edematous syndrome), which increase in proportion to the decrease in renal function. Increase in blood pressure, changes in intracardial hemodynamics, deterioration of arterial compliance contribute to the acceleration of cardiovascular events. The role of laboratory predictors of renal dysfunction in the progression of cardiovascular disorders is discussed. The general approaches of echocardiographic visualization of the heart cavities and its importance in the diagnosis of cardiovascular diseases are discussed. Special attention is paid to the development of pulmonary arterial hypertension, changes in the left and right ventricle of the myocardium with renal dysfunction.

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“…Recently, pulmonary hypertension has been increasingly recognized as a novel threat in patients with end-stage renal disease (ESRD), with an estimated prevalence range of 0 -68.8% (3)(4)(5)(6)(7). The mechanisms involved in pulmonary hypertension development are still under investigation.…”

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confidence: 99%

Association of Pulmonary Hypertension with Mortality in Incident Peritoneal Dialysis Patients

Xu¹,

Xiong²,

Fan³

et al. 2015

Perit Dial Int

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♦ Background: The prognostic value of pulmonary hypertension at the start of peritoneal dialysis (PD) in patient survival is unclear. ♦ Methods: We conducted a retrospective study of incident patients who initiated PD therapy from January 2007 to December 2011, and followed up through June 2013. Pulmonary hypertension was defined as an estimated systolic pulmonary artery pressure (PAP) of ≥ 35 mm Hg using echocardiography. Clinical parameters and laboratory findings were compared between patients with and without pulmonary hypertension and a logistic regression model was elaborated. Patient outcomes (all-cause and cardiovascular mortality) were recorded during follow-up. Survival curves were constructed by the Kaplan-Meier method, and the influences of pulmonary hypertension on outcomes were analyzed by Cox regression models. .1% of them due to cardiovascular disease. Kaplan-Meier survival analysis showed that patients with pulmonary hypertension had worse overall rates of survival and cardiovascular death-free survival than those without pulmonary hypertension. After multivariate adjustment, pulmonary hypertension was independently associated with increased risk for both all-cause and cardiovascular mortality, with hazard ratios (HRs) of 2.10 (95% CI: 1.35 -3.27) and 2.60 (95% CI: 1.48 -4.56), respectively. ♦ Conclusions: The prevalence of pulmonary hypertension at the start of PD was common and associated with increased risk of both all-cause and cardiovascular mortality in incident PD patients. KEY WORDS: End-stage renal disease; peritoneal dialysis; pulmonary hypertension; survival. P ulmonary hypertension is a devastating disorder, characterized by a progressive increase in pulmonary vascular resistance and pulmonary artery pressure (PAP), leading to right heart failure or even death (1,2). Recently, pulmonary hypertension has been increasingly recognized as a novel threat in patients with end-stage renal disease (ESRD), with an estimated prevalence range of 0 -68.8% (3-7). The mechanisms involved in pulmonary hypertension development are still under investigation. However, it has been suggested that some factors responsible for this pathogenesis include pulmonary artery calcifications secondary to hyperparathyroidism, volume overload, severe anemia, hemodynamic modifications due to the size or the location of an arteriovenous fistula, and exposure to dialysis membranes. In contrast, pulmonary hypertension improves after successful kidney transplantation (8).Previous studies have demonstrated that pulmonary hypertension, either pre-existing before initiating hemodialysis (HD) or developing incident after regular HD treatment, is related to increased mortality rates (5,7,9). Further, enhanced PAP has a poor survival rate extending to a period beyond dialysis. In a study regarding renal transplant recipients, severe pulmonary hypertension, defined as mean PAP > 50 mmHg, conferred a hazard ratio (HR) of 3.75 (95% confidence

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Pulmonary Hypertension in Dialysis Patients

Cited by 14 publications

References 8 publications

Pulmonary hypertension in patients with stage 1-3 chronic kidney disease

Pulmonary hypertension in patients with stage 1-3 chronic kidney disease

Effect of Renal Dysfunction on the Cardiacvascular System. The Possibili Ties of Early Diagnosis of the Renal Dysfunction

Association of Pulmonary Hypertension with Mortality in Incident Peritoneal Dialysis Patients

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