Pulmonary hypertension: Tortuous route to diagnosis

Riolo, Giovanna; Ghamdi, Bader Al; D’Arsigny, Christine L.

doi:10.1002/rcr2.5

Cited by 3 publications

(6 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Residual elevations of PVR may be related to long-term vascular endothelial changes as a consequence of arteriovenous fistulae placement and the subsequent development of increased cardiac output. 26,27 Finally, prior studies show that volume expansion in kidney disease is associated with hypertension. Our finding that patient's required fewer anti-hypertensive medications post-intervention supports the claim that volume overload is a central issue in these patients.…”

Section: Discussionmentioning

confidence: 97%

Intensive ultrafiltration strategy restores kidney transplant candidacy for patients with echocardiographic evidence of pulmonary hypertension

Mihaltses¹,

Kennedy

Rao

et al. 2022

Clinical Transplantation

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 97%

Intensive ultrafiltration strategy restores kidney transplant candidacy for patients with echocardiographic evidence of pulmonary hypertension

Mihaltses¹,

Kennedy

Rao

et al. 2022

Clinical Transplantation

View full text Add to dashboard Cite

show abstract

“…The main acute hemodynamic changes observed after AVF creation include a drop in peripheral resistance, an expansion of the blood volume with increased left ventricular end diastolic diameter (LVEDD), an increase in sympathetic nervous system activity with increased contractility, heart rate and stroke volume and an increase in cardiac output (CO) in order to maintain blood pressure (3, 22–31). The extra volume load imposed by the AVF increases pulmonary blood flow (22, 24, 26, 32) and can lead to HF secondary to pulmonary hypertension (33, 34).…”

Section: Hemodynamic Effects Of Avf Creationmentioning

confidence: 99%

Permanent Arteriovenous Fistula or Catheter Dialysis for Heart Failure Patients

Roca-Tey

2016

J Vasc Access

View full text Add to dashboard Cite

Heart failure (HF) is the most frequent cardiovascular disease associated with chronic kidney disease and represents a high risk for cardiovascular mortality in incident hemodialysis (HD) patients. This risk is especially high during the arteriovenous fistula (AVF) maturation period due to the marked hemodynamic changes related to the large increase in the blood flow and also within the first 120 days after HD inception because in this period the highest mortality rate occurs. When planning the vascular access for each incident HF patient, the risk of aggravating HF after AVF creation must be evaluated carefully alongside the risk of catheter-related complications, but avoiding a non-selective 'catheter first' approach for all these patients. HF patients classified within the New York Heart Association (NYHA) Class I-II and the American College of Cardiology/American Heart Association (ACC/AHA) Stage A-B could initiate HD through a distal arm AVF. High-flow brachial artery-based AVF creation must be avoided because it displays the highest risk of worsening the cardiac function. The decision for AVF creation or tunneled central catheter placement in HF patients classified within the NYHA Class III and the ACC/AHA Stage C must have been individualized according the degree of systolic and/or diastolic dysfunction. HF patients with significant reduction in systolic function (ejection fraction lower than 30%) or classified within the NYHA Class IV and the ACC/AHA Stage D, are candidates for tunneled catheter placement to start HD treatment.

show abstract

“…PH secondary to high output AVF is also a diagnosis of exclusion. Right heart catheterization reveals elevated pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) with normal left sided pressures . Following ligation of the access, the pulmonary pressures either decrease or normalize with time .…”

Section: Pulmonary Hypertensionmentioning

confidence: 99%

“…Right heart catheterization reveals elevated pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) with normal left sided pressures . Following ligation of the access, the pulmonary pressures either decrease or normalize with time . Concurrent phosphodiesterase 5 inhibitors (PDE5i) or endothelin receptor antagonists may also be needed.…”

Section: Pulmonary Hypertensionmentioning

confidence: 99%

“…Concurrent phosphodiesterase 5 inhibitors (PDE5i) or endothelin receptor antagonists may also be needed. Failure of mPAP and PVR to normalize after AVF ligation, after all other secondary causes have been ruled out, indicates a fixed vasculopathy . Doppler echocardiography during exercise has been recommended to detect subclinical PH in ESRD patients prior to fistula placement .…”

Section: Pulmonary Hypertensionmentioning

confidence: 99%

See 1 more Smart Citation

Complications of a High‐flow Access and Its Management

Sequeira

Tan

2015

Seminars in Dialysis

View full text Add to dashboard Cite

A high-flow access has been defined as one with a flow >1-1.5 l/minute or as one where the access flow is >20% of the cardiac output. Although it may be asymptomatic, it can be associated with cardiopulmonary complications, aneurysms, central vein stenosis and the distal hypoperfusion ischemic syndrome in some patients. The decision for surgical intervention should be made after careful medical optimization especially in patients with high output cardiopulmonary compromise. In this review, we present a summary of current knowledge about the pathophysiology of a high-flow fistula, followed by a concise, comprehensive synopsis of current medical and surgical therapy.

show abstract

Pulmonary hypertension: Tortuous route to diagnosis

Cited by 3 publications

References 5 publications

Intensive ultrafiltration strategy restores kidney transplant candidacy for patients with echocardiographic evidence of pulmonary hypertension

Intensive ultrafiltration strategy restores kidney transplant candidacy for patients with echocardiographic evidence of pulmonary hypertension

Permanent Arteriovenous Fistula or Catheter Dialysis for Heart Failure Patients

Complications of a High‐flow Access and Its Management

Contact Info

Product

Resources

About