Treatment of secondary pulmonary hypertension with bosentan and its pharmacokinetic monitoring in ESRD

Liefeldt, Lutz; Giersbergen, Paul L. M. van; Dingemanse, Jasper; Rudolph, Birgit; Walde, Torsten; Budde, Klemens; Neumayer, Hans‐H.; Hocher, Berthold

doi:10.1053/j.ajkd.2003.12.054

Cited by 20 publications

(13 citation statements)

References 11 publications

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“…These impaired pathways represent a target for different pharmacological agents [37][38][39][40]. Treatments include conventional agents (anticoagulants, diuretics, digoxin, and supplementary oxygen, as well as calcium antagonists in selected patients), vasodilators, and antiproliferative agents such as prostanoids and endothelin-receptor antagonists, which are targeted at abnormalities of endothelial function [40,41].…”

Section: Therapeutic Perspectivesmentioning

confidence: 99%

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Pulmonary hypertension in chronic dialysis patients with arteriovenous fistula: pathogenesis and therapeutic prospective

Abassi

Nakhoul

Khankin

et al. 2006

Current Opinion in Nephrology &Amp; Hypertension

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We propose different potential mechanisms as explanations for the development of pulmonary hypertension. Hormonal and metabolic derangement associated with end-stage renal disease might lead to pulmonary arterial vasoconstriction and an increase in pulmonary vascular resistance. Pulmonary arterial pressure may be further increased by high cardiac output resulting from the arteriole-venous access itself, worsened by commonly occurring anaemia and fluid overload.

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Section: Therapeutic Perspectivesmentioning

confidence: 99%

“…Five agents [41] are currently approved for the treatment of pulmonary arterial hypertension in the United States and Europe.…”

Section: Therapeutic Perspectivesmentioning

confidence: 99%

Pulmonary hypertension in chronic dialysis patients with arteriovenous fistula: pathogenesis and therapeutic prospective

Abassi

Nakhoul

Khankin

et al. 2006

Current Opinion in Nephrology &Amp; Hypertension

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“…Chronic hemodialysis (HD) patients show higher endothelin-1 (ET-1) activity in comparison to healthy individuals and there is evidence that the pulmonary vascular resistance increase in these patients is at least in part mediated by ET-1 [99,100] . Recent data show good results after therapy with bosentan in HD patients with PH [99] . PH therapy in end-stage renal disease patients appeared not only effective, but also safe, without the necessity of any adjustment of the bosentan dosing regimen.…”

Section: Bosentanmentioning

confidence: 99%

“…Because bosentan is mainly cleared by hepatic elimination, severe renal dysfunction does not signifi cantly affect the appropriate dose and bosentan dialysis clearance is very low [99] . Chronic hemodialysis (HD) patients show higher endothelin-1 (ET-1) activity in comparison to healthy individuals and there is evidence that the pulmonary vascular resistance increase in these patients is at least in part mediated by ET-1 [99,100] .…”

Section: Bosentanmentioning

confidence: 99%

Advances in the Medical Treatment of Pulmonary Hypertension

Dandel

Lehmkuhl²,

Hetzer³

2005

Kidney Blood Press Res

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Increased pulmonary precapillary vascular resistance due to vasoconstriction and vasoproliferative processes is the basic pathophysiological mechanism in the development of pulmonary hypertension (PH). With the exception of pulmonary venous hypertension, where the primary cause of PH is left ventricular failure or mitral valvular disease, all the other PH categories will benefit to a greater or lesser extent from pulmonary vasodilator and antivasoproliferative therapy. Today, for this purpose, in addition to intravenous prostacyclin (epoprostenol), which is restricted to severe pulmonary arterial hypertension (NYHA class IV and late class III), other therapeutic options such as treatment with more stable prostacyclin analogs (oral beraprost, aerosolized iloprost), endothelin-receptor antagonists (bosentan) or phosphodiesterase inhibitors (sildenafil) are also available and these are especially useful for the treatment of the early stages of the disease. The recent progress in medical therapy has markedly increased the life expectancy in patients with pulmonary arterial hypertension and substantially improved their quality of life. Chronic hemodialysis (HD) patients show higher endothelin-1 (ET-1) activity in comparison to healthy individuals and there is evidence that the increase of pulmonary vascular resistance in these patients is at least in part mediated by ET-1. Recent data show good results after PH therapy with the endothelin-receptor antagonist bosentan in HD patients. Also prostacyclin and its analogs, as well as phosphodiesterase inhibitors, can be useful for the treatment of pulmonary hypertension in patients with chronic renal failure.

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“…The bosentan dosing regimen for patients with renal failure does not need any adjustment, because it is metabolized by the liver. 17) Furthermore, patients on hemodialysis have specific problems with medications for PH. Firstly, sometimes it is difficult to stop bleeding at blood access sites with anticoagulants.…”

Section: )mentioning

confidence: 99%

Bosentan Improved Syncope in a Hemodialysis Patient With Pulmonary Hypertension and Mild Aortic Stenosis

et al. 2006

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SUMMARYPulmonary arterial hypertension (PAH), caused by collagen diseases, Eisenmenger syndrome or of idiopathic etiology, generally has a poor prognosis. Recently, bosentan, a dual endothelin receptor antagonist, has become available for treating PAH. This report describes a bosentan-effective case of combined PAH, hemodialysis and mild aortic stenosis. A 71-year-old woman on hemodialysis was referred to our hospital because of repetitive syncope. Although neurological examinations revealed no etiological diseases, echocardiography and cardiac catheterization showed PAH and mild aortic valve stenosis. Bosentan abolished syncope with improvement of hemodynamic parameters. This report suggests bosentan was clinically useful in a hemodialysis patient with pulmonary hypertension and mild aortic valve stenosis. (Int Heart J 2006; 47: 911-917)

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Treatment of secondary pulmonary hypertension with bosentan and its pharmacokinetic monitoring in ESRD

Cited by 20 publications

References 11 publications

Pulmonary hypertension in chronic dialysis patients with arteriovenous fistula: pathogenesis and therapeutic prospective

Pulmonary hypertension in chronic dialysis patients with arteriovenous fistula: pathogenesis and therapeutic prospective

Advances in the Medical Treatment of Pulmonary Hypertension

Bosentan Improved Syncope in a Hemodialysis Patient With Pulmonary Hypertension and Mild Aortic Stenosis

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