Right Ventricular Dysfunction in Patients with End-Stage Renal Disease

Paneni, Francesco; Gregori, Mario; Ciavarella, Giuseppino Massimo; Sciarretta, Sebastiano; Biase, Luciano De; Marino, Luca; Tocci, Giuliano; Principe, Francesco; Domenici, Alessandro; Luciani, Remo; Punzo, Giorgio; Menè, Paolo; Volpe, Massimo

doi:10.1159/000320755

Cited by 82 publications

(102 citation statements)

References 45 publications

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“…Our study, similar to other ones, 5,8,27 showed an increased risk of PAH in patients on HD compared with patients on PD. Multivariate analyses in our study showed that this higher risk is independent of anemia, presence of AVF, level of creatinine, and degree of systolic and diastolic cardiac dysfunction.…”

Section: The Effects Of Dialysis Typesupporting

confidence: 92%

Pulmonary Hypertension among Patients on Dialysis and Kidney Transplant Recipients

et al. 2013

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Pulmonary arterial hypertension (PAH) is a serious cardiac complication among patients with end-stage renal disease (ESRD). We investigated pulmonary hypertension and its associated factors among patients who were on chronic dialysis and kidney transplant recipients. One hundred-eighty patients in three groups of hemodialysis (HD), peritoneal dialysis (PD), and kidney transplant were studied. Demographic and clinical characteristics and echocardiographic findings were evaluated. A multivariable linear regression model was used to find factors associated with pulmonary artery pressure. The mean age of participants was 50.3 AE 15.5 years and 63.9% were male. We found pulmonary hypertension (mean pulmonary artery pressure >25 mmHg) in 31.6%, 8.3%, and 5% of the patients on HD, PD, and transplant recipients, respectively (p < 0.001). In multivariate analyses, being on HD (B ¼ 5.276, confidence interval [CI] 95%: 1.211-9.341), age (B ¼ -0.319, CI 95%: -0.501 to -0.138), smoking (B ¼ 11.631, CI 95%: 1.847-21.416), systolic cardiac dysfunction (B ¼ 6.313, CI 95%: 3.073-9.554), and diastolic cardiac dysfunction (B ¼ 5.227, CI 95%: 1.176-9.277) were associated with systolic pulmonary artery pressure. These results showed that pulmonary hypertension is a frequent cardiac complication among patients with ESRD, and the type of renal replacement therapy (HD), systolic and diastolic cardiac dysfunction, and smoking are associated with increased pulmonary artery pressure. Further studies with larger sample sizes and also prospective studies are recommended in this regard.

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Section: The Effects Of Dialysis Typesupporting

confidence: 92%

Pulmonary Hypertension among Patients on Dialysis and Kidney Transplant Recipients

et al. 2013

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“…The arteriovenous fistula causes a left-to-right shunt, leading to chronic volume overload and right ventricle function impairment [10,17] .…”

Section: Discussionmentioning

confidence: 99%

Clinical and Echocardiographic Factors Associated with Right Ventricular Systolic Dysfunction in Hemodialysis Patients

et al. 2016

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Background: Chronic kidney disease is a disorder of epidemic proportions that impairs cardiac function. Cardiovascular diseases are the leading cause of death in hemodialysis patients, and the understanding of new nontraditional predictors of mortality could improve their outcomes. Right ventricular systolic dysfunction (RVSD) has recently been recognized as a predictor of cardiovascular death in heart failure and hemodialysis patients. However, the factors contributing to RVSD in hemodialysis patients remain unknown. The aim of this study was to evaluate the clinical and echocardiographic factors associated with RVSD in hemodialysis patients. Methods: A cross-sectional study was conducted in which 100 outpatients with endstage renal disease on chronic hemodialysis were evaluated. A transthoracic echocardiographic examination was performed at optimal dry weight. Right ventricular systolic function was evaluated using tricuspid annular plane systolic excursion (TAPSE). Clinical and echocardiographic data were recorded for each patient. A multivariate linear logistic regression was created using RVSD (TAPSE <14 mm) as the dependent variable. Results: Fifteen patients with RVSD and 85 patients without RVSD were analyzed. TAPSE had a positive correlation with left ventricular ejection fraction (LVEF) and myocardial relaxation velocity. Independent contributors to RVSD were LVEF (OR 1.14, 95% CI 1.05-1.26), left ventricular mass index (OR 1.02, 95% CI 1.00-1.04), and myocardial relaxation velocity (OR 1.81, 95% CI 1.18-3.19). Conclusions: Echocardiographic factors were significant contributors to RVSD. These measurements could be included as part of the routine workup in all end-stage renal disease patients on hemodialysis.

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“…Both these measures were significantly more compromised in the HD cohort. As long as CKD patients new to dialysis entered our RRT program, we were able to extend our observation in a larger study (Paneni et al, 2010), including 94 patients on HD, 62 dialyzed trough a radial AVF and 32 trough a brachial AVF, and 26 on PD, most of whom on nightly automated PD (APD), compared with 100 healthy controls matched for age, gender and BMI. Patients on RRT did not differ with regards to the prevalence of hypertension and diabetes and type of medications used.…”

Section: What We Have Donementioning

confidence: 70%