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Curtis KA, Waikar SS, Mc Causland FR. Higher NT-proBNP levels and the risk of intradialytic hypotension at hemodialysis initiation. Hemodial Int 2024; 28:77-84. [PMID: 37875429 DOI: 10.1111/hdi.13125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 10/26/2023]
Abstract
INTRODUCTION Elevated N-terminal pro B-type natriuretic peptide (NT-proBNP) is a potent predictor of adverse outcomes in hemodialysis initiation. These patients often experience intradialytic hypotension, which may partially reflect cardiac dysfunction, but the association of NT-proBNP with intradialytic hypotension is not clear. METHODS We performed a post hoc analysis of a randomized trial that tested mannitol versus placebo in 52 patients initiating hemodialysis (NCT01520207). NT-proBNP was measured prior to the first and third sessions (n = 87). Mixed-effects models (adjusting for randomized treatment, sex, race, age, diabetes, heart failure, catheter use, pre-dialysis systolic blood pressure, pre-dialysis weight, ultrafiltration volume, serum sodium, bicarbonate, urea nitrogen, phosphate, albumin, hemoglobin, and session length) were fit to examine the association of NT-proBNP with systolic blood pressure decline (pre-dialysis minus nadir systolic blood pressure). Additionally, mixed-effects Poisson models were fit to examine the association with intradialytic hypotension (≥20 mmHg decline in systolic blood pressure). FINDINGS Mean age was 55 ± 16 years; 33% had baseline heart failure. The median NT-proBNP was 5498 [25th-75th percentile 2011, 14,790] pg/mL; 26 sessions (30%) were complicated by intradialytic hypotension. In adjusted models, each unit higher log-NT-proBNP was associated with 6.0 mmHg less decline in systolic blood pressure (95%CI -9.2 to -2.8). Higher pre-dialysis NT-proBNP, per log-unit, was associated with a 52% lower risk of intradialytic hypotension (IRR 0.48, 95%CI 0.23-0.97), without evidence for effect modification by randomized treatment (P-interaction = 0.17). DISCUSSION In patients initiating hemodialysis, higher NT-proBNP is associated with less decline in intradialytic systolic blood pressure and lower risk of intradialytic hypotension. Future studies should investigate if higher pre-dialysis NT-proBNP levels may identify patients who might tolerate more aggressive ultrafiltration.
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Affiliation(s)
- Katherine A Curtis
- Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Milken Institute School of Public Health, The George Washington University, Washington DC, USA
| | - Sushrut S Waikar
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Finnian R Mc Causland
- Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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de Simone G, Mancusi C. Diastolic function in chronic kidney disease. Clin Kidney J 2023; 16:1925-1935. [PMID: 37915916 PMCID: PMC10616497 DOI: 10.1093/ckj/sfad177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Indexed: 11/03/2023] Open
Abstract
Chronic kidney disease (CKD) is characterized by clustered age-independent concentric left ventricular (LV) geometry, geometry-independent systolic dysfunction and age and heart rate-independent diastolic dysfunction. Concentric LV geometry is always associated with echocardiographic markers of abnormal LV relaxation and increased myocardial stiffness, two hallmarks of diastolic dysfunction. Non-haemodynamic mechanisms such as metabolic and electrolyte abnormalities, activation of biological pathways and chronic exposure to cytokine cascade and the myocardial macrophage system also impact myocardial structure and impair the architecture of the myocardial scaffold, producing and increasing reactive fibrosis and altering myocardial distensibility. This review addresses the pathophysiology of diastole in CKD and its relations with cardiac mechanics, haemodynamic loading, structural conditions, non-haemodynamic factors and metabolic characteristics. The three mechanisms of diastole will be examined: elastic recoil, active relaxation and passive distensibility and filling. Based on current evidence, we briefly provide methods for quantification of diastolic function and discuss whether diastolic dysfunction represents a distinct characteristic in CKD or a proxy of the severity of the cardiovascular condition, with the potential to be predicted by the general cardiovascular phenotype. Finally, the review discusses assessment of diastolic function in the context of CKD, with special emphasis on end-stage kidney disease, to indicate whether and when in-depth measurements might be helpful for clinical decision making in this context.
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Affiliation(s)
- Giovanni de Simone
- Hypertension Research Center and Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Costantino Mancusi
- Hypertension Research Center and Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
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Dai L, Yang Y, Liu L, Long C, Da J, Chen S, Zhao J, Shen Y, Huang C, Zha Y, Yuan J. The association of left ventricular fraction shortening with cardiovascular events in peritoneal dialysis patients. Ren Fail 2023; 45:2261786. [PMID: 37779359 PMCID: PMC11001333 DOI: 10.1080/0886022x.2023.2261786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 09/18/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Peritoneal dialysis (PD) patients have a high incidence of cardiovascular events (CVEs). Left ventricular fraction shortening (LVFS), one of the echocardiographic parameters, is an independent risk factor for mortality in previous studies. The aim of this study was to evaluate associations between LVFS and CVEs in PD patients. METHODS This was a single-center observational cohort study. Seven hundred and eighty-four PD patients were enrolled from 1 January 2012 to 1 June 2021 and followed until 1 June 2022. The primary outcome was the incidence of CVEs. PD patients were categorized into three groups according to the tertiles of LVFS levels (tertile 1-tertile 3). Kaplan-Meier method, Cox proportional hazard models and competing risk regression models were used for survival analysis. The areas under the curve (AUC) of receiver-operating characteristic analysis was used to determine the predictive values of LVFS for CVEs. A preplanned subgroup analysis was assessed according to age, gender, and the presence of hypertension and dyslipidemia, etc. RESULTS During a median follow-up period of 42.3 months (interquartile range 24.0-79.0 months), 259 CVEs occurred. Compared to the other two groups respectively, patients in tertile 3 group had the lowest incidence of CVEs (24.5% vs 31.6% vs 43.0%, respectively, p < 0.05). After multiple adjustments, the tertile 3 group was associated with the 45.1% decrease in the CVEs hazard compared to that of the tertile1 group (SHR = 0.549, 95%CI: 0.395-0.762, p < 0.001). Subgroup analysis demonstrated that tertile 1 group as the reference, the association between LVFS and CVEs in tertile 3 group was robust among female patients (HR = 0.506, 95%CI: 0.309-0.829, p = 0.007), aged < 45 years (HR = 0.496, 95%CI: 0.331-0.744, p = 0.001), history of hypertension (HR = 0.586, 95%CI: 0.349-0.872, p = 0.008) and combined with dyslipidemia (HR = 0.464, 95%CI: 0.269-0.799, p = 0.006). CONCLUSIONS This study suggests that LVFS is independently associated with the increased risk of CVEs in PD patients, especially those with aged < 45 years, female, with hypertension and dyslipidemia.
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Affiliation(s)
- Lu Dai
- Department of Nephrology, Guizhou Provincial People’s Hospital, Guiyang, China
- Key Laboratory of Diagnosis and Treatment of Pulmonary Immuned-related Diseases, NHC, Guiyang, China
| | - Yuqi Yang
- Department of Nephrology, Guizhou Provincial People’s Hospital, Guiyang, China
- Key Laboratory of Diagnosis and Treatment of Pulmonary Immuned-related Diseases, NHC, Guiyang, China
| | - Lu Liu
- Department of Nephrology, Guizhou Provincial People’s Hospital, Guiyang, China
- Key Laboratory of Diagnosis and Treatment of Pulmonary Immuned-related Diseases, NHC, Guiyang, China
| | - Changzhu Long
- Department of Nephrology, Guizhou Provincial People’s Hospital, Guiyang, China
- Key Laboratory of Diagnosis and Treatment of Pulmonary Immuned-related Diseases, NHC, Guiyang, China
| | - Jingjing Da
- Department of Nephrology, Guizhou Provincial People’s Hospital, Guiyang, China
- Key Laboratory of Diagnosis and Treatment of Pulmonary Immuned-related Diseases, NHC, Guiyang, China
| | - Shuang Chen
- Department of Nephrology, Guizhou Provincial People’s Hospital, Guiyang, China
- Key Laboratory of Diagnosis and Treatment of Pulmonary Immuned-related Diseases, NHC, Guiyang, China
| | - Jianqiu Zhao
- Department of Nephrology, Guizhou Provincial People’s Hospital, Guiyang, China
- Key Laboratory of Diagnosis and Treatment of Pulmonary Immuned-related Diseases, NHC, Guiyang, China
| | - Yan Shen
- Department of Nephrology, Guizhou Provincial People’s Hospital, Guiyang, China
- Key Laboratory of Diagnosis and Treatment of Pulmonary Immuned-related Diseases, NHC, Guiyang, China
| | - Chengchong Huang
- Department of Nephrology, Guizhou Provincial People’s Hospital, Guiyang, China
- Key Laboratory of Diagnosis and Treatment of Pulmonary Immuned-related Diseases, NHC, Guiyang, China
| | - Yan Zha
- Department of Nephrology, Guizhou Provincial People’s Hospital, Guiyang, China
- Key Laboratory of Diagnosis and Treatment of Pulmonary Immuned-related Diseases, NHC, Guiyang, China
| | - Jing Yuan
- Department of Nephrology, Guizhou Provincial People’s Hospital, Guiyang, China
- Key Laboratory of Diagnosis and Treatment of Pulmonary Immuned-related Diseases, NHC, Guiyang, China
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Law JP, Pickup L, Pavlovic D, Townend JN, Ferro CJ. Hypertension and cardiomyopathy associated with chronic kidney disease: epidemiology, pathogenesis and treatment considerations. J Hum Hypertens 2023; 37:1-19. [PMID: 36138105 DOI: 10.1038/s41371-022-00751-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/09/2022] [Accepted: 08/31/2022] [Indexed: 01/31/2023]
Abstract
Chronic kidney disease (CKD) is a complex condition with a prevalence of 10-15% worldwide. An inverse-graded relationship exists between cardiovascular events and mortality with kidney function which is independent of age, sex, and other risk factors. The proportion of deaths due to heart failure and sudden cardiac death increase with progression of chronic kidney disease with relatively fewer deaths from atheromatous, vasculo-occlusive processes. This phenomenon can largely be explained by the increased prevalence of CKD-associated cardiomyopathy with worsening kidney function. The key features of CKD-associated cardiomyopathy are increased left ventricular mass and left ventricular hypertrophy, diastolic and systolic left ventricular dysfunction, and profound cardiac fibrosis on histology. While these features have predominantly been described in patients with advanced kidney disease on dialysis treatment, patients with only mild to moderate renal impairment already exhibit structural and functional changes consistent with CKD-associated cardiomyopathy. In this review we discuss the key drivers of CKD-associated cardiomyopathy and the key role of hypertension in its pathogenesis. We also evaluate existing, as well as developing therapies in the treatment of CKD-associated cardiomyopathy.
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Costa FL, Reis NSDC, Reis FM, de Oliveira RC, Zanati Bazan SG, Canedo da Silva MZ, Martin LC, Barretti P. Multifrequency bioimpedance by spectroscopy vs. routine methods in the management of hydration status in peritoneal dialysis patients: A randomized control trial. Front Med (Lausanne) 2022; 9:911047. [PMID: 36160161 PMCID: PMC9492968 DOI: 10.3389/fmed.2022.911047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Overhydration (OH) is common in peritoneal dialysis (PD) and increases the cardiovascular risk. Multifrequency bioimpedance spectroscopy (BIS) has been proposed to estimate the hydration in dialysis. Our objective was to evaluate if BIS is superior than control based on clinical assessment plus single-frequency bioimpedance (SF-BIA) on the fluid control and intermediate cardiovascular outcomes. Methods Randomized controlled study in adult PD patients, with a 9-month follow-up, allocated into two groups: control and BIS. Data were collected from medical records. SF-BIA and BIS, laboratory exams, ambulatory blood pressure monitoring, echocardiography (ECHO), and pulse wave velocity (PWV) were evaluated. The BIS data were available to the medical team only in BIS group. Results 34 patients completed the study, 17 in each group. At the endpoint the BIS group had a significant (p < 0.05) greater proportion of patients with OH/extracellular water (OH/ECW%) ≤ 15% than the control (94.1% vs. 52.9%), and a lower OH mean (2.1 ± 1.6 vs. 0.9 ± 1.1 L). The control group has a significant increase in the tumor necrosis factor alpha median concentration from baseline to six [11.9 (6.0–24.1) vs. 44.7 (9.4–70.6) pg/ml] and 9 months [11.9 (6.0–24.1) vs. 39.4 (27.9–62.6) pg/ml], and in the N-terminal fragment of pro-B-type natriuretic peptide median [239 (171.5–360.5) vs. 356 (219–1,555) pg/ml]. For cardiovascular parameters, BIS group presented a significant reduction in radial PWV [7.7 (6.9–9.2) vs. 6.5 (5.5–8.4) m/s] at 9 month, while in the control presented a significant increase in mean central systolic blood pressure (BP) (106.8 ± 11.2 vs. 117.6 ± 16.5 mmHg) and in central diastolic BP (90.4 ± 9.8 vs. 103.3 ± 12.5 mmHg) at 9 months. The left ventricular mass (LVM)/body surface presented a significant reduction in the control (109.6 ± 30.8 vs. 101.2 ± 28.9 g/m2) and BIS group (107.7 ± 24.9 vs. 96.1 ± 27.0 g/m2) at 9 months. Conclusion The results suggest BIS is superior than the clinical evaluation plus SF-BIA for the fluid control of PD patients. Clinical trial registration [https://www.ClinicalTrials.gov], identifier [RBR-10k8j3bx].
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Suh SH, Oh TR, Choi HS, Kim CS, Bae EH, Oh KH, Lee J, Jung JY, Lee KB, Ma SK, Kim SW. Association Between Left Ventricular Geometry and Renal Outcomes in Patients With Chronic Kidney Disease: Findings From Korean Cohort Study for Outcomes in Patients With Chronic Kidney Disease Study. Front Cardiovasc Med 2022; 9:848692. [PMID: 35509274 PMCID: PMC9058055 DOI: 10.3389/fcvm.2022.848692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/30/2022] [Indexed: 01/19/2023] Open
Abstract
Background The impact of left ventricular (LV) geometry on the renal outcomes in patients with chronic kidney disease (CKD) has not been established yet. We aimed to investigate the association of LV geometry with renal outcomes and all-cause mortality in patients with pre-dialysis CKD. Methods A total of 2,144 subjects from the Korean Cohort Study for Outcome in Patients With Chronic Kidney Disease (KNOW-CKD) were categorized by LV geometry, which was defined by LV mass index and relative wall thickness [normal geometry, concentric remodeling, eccentric hypertrophy (eLVH), and concentric hypertrophy (cLVH)]. Study outcomes were composite renal events [decline of kidney function (the first occurrence of > 50% decline of eGFR or doubling of serum creatinine from the baseline) and onset of ESRD (initiation of dialysis or kidney transplantation) during follow-up periods)] and all-cause mortality. Results Cox regression analysis revealed that eLVH [adjusted hazard ratio (HR) 1.498, 95% confidence interval (CI) 1.197–1.873] and cLVH (adjusted HR 1.289, 95% CI 1.011–1.643) were associated with increased risk of composite renal events, whereas concentric remodeling (adjusted HR 1.881, 95% CI 1.135–3.118) and cLVH (adjusted HR 2.216, 95% CI 1.341–3.664) were associated with increased risk of all-cause mortality. Sensitivity analyses confirmed that concentric remodeling (adjusted HR 1.993, 95% CI 1.197–3.368) and eLVH (adjusted HR 1.588, 95% CI 1.261–2.001) are independently associated with all-cause mortality and composite renal events, respectively. Conclusion In conclusion, we report that LV geometry is significantly associated with adverse renal outcomes and all-cause mortality in patients with pre-dialysis CKD. Echocardiographic determination of LV geometry may help the early identification for the patients with high risk of CKD progression.
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Affiliation(s)
- Sang Heon Suh
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, South Korea
| | - Tae Ryom Oh
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, South Korea
| | - Hong Sang Choi
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, South Korea
| | - Chang Seong Kim
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, South Korea
| | - Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, South Korea
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Joongyub Lee
- Department of Prevention and Management, School of Medicine, Inha University, Incheon, South Korea
| | - Ji Yong Jung
- Division of Nephrology, Department of Internal Medicine, Gachon University of Gil Medical Center, Incheon, South Korea
| | - Kyu-Beck Lee
- Department of Internal Medicine, School of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University Seoul, Seoul, South Korea
| | - Seong Kwon Ma
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, South Korea
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, South Korea
- *Correspondence: Soo Wan Kim,
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Keller N, Monnier A, Caillard S, Cognard N, Geny B, Moulin B, Talha S. High-flow arteriovenous fistula and hemodynamic consequences at 1 year after kidney transplantation. Semin Dial 2021; 35:171-180. [PMID: 34726295 DOI: 10.1111/sdi.13028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/18/2021] [Accepted: 09/24/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION There are only scarce data regarding the cardiovascular impact of arteriovenous fistula after kidney transplantation depending on fistula flow. METHODS We performed a single-center, prospective, cohort study including 49 patients with a functional fistula at 1 year from kidney transplantation. Patients were convened for a clinical work-up, a biological analysis, a fistula's Doppler ultrasonography and an echocardiography. Main judgment criterion was comparison of echocardiography parameters between patients with relative (fistula flow >1 L/min and a fistula flow/cardiac output ratio >20%), absolute high-flow fistula (fistula flow >2 L/min) and normal-flow fistula. RESULTS High-flow fistula frequency was 69%. Significantly higher left ventricular end-diastolic and systolic diameters were observed in this group compared with the normal-flow fistula group (53 ± 6 vs. 48 ± 7 mm; p = 0.04 and 33 ± 6 vs. 28 ± 8 mm; p = 0.02) and between the absolute and relative high-flow fistula subgroups (56 ± 6 vs. 51 ± 6 mm; p = 0.009 and 35 ± 6 vs. 31 ± 5 mm; p = 0.01). The study showed no other significant differences. CONCLUSIONS This study showed a significantly higher but not pathological left ventricular end-diastolic and systolic diameters values in patients with high-flow fistula compared with patients with normal-flow fistula and between patients with respectively absolute and relative high-flow fistula.
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Affiliation(s)
- Nicolas Keller
- Department of Nephrology and Transplantation, Nouvel Hôpital Civil, Strasbourg, France
| | - Alexandra Monnier
- Medical Intensive Care Unit, Nouvel Hôpital Civil, Strasbourg, France
| | - Sophie Caillard
- Department of Nephrology and Transplantation, Nouvel Hôpital Civil, Strasbourg, France
| | - Noëlle Cognard
- Department of Nephrology and Transplantation, Nouvel Hôpital Civil, Strasbourg, France
| | - Bernard Geny
- Department of Physiology and Functional Explorations, Nouvel Hôpital Civil, Strasbourg, France
| | - Bruno Moulin
- Department of Nephrology and Transplantation, Nouvel Hôpital Civil, Strasbourg, France
| | - Samy Talha
- Department of Physiology and Functional Explorations, Nouvel Hôpital Civil, Strasbourg, France
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Alexandrou ME, Sarafidis P, P Theodorakopoulou Μ, Sachpekidis V, Papadopoulos C, Loutradis C, Kamperidis V, Boulmpou A, Bakaloudi DR, Faitatzidou D, Pateinakis P, Papagianni A. Cardiac geometry, function, and remodeling patterns in patients under maintenance hemodialysis and peritoneal dialysis treatment. Ther Apher Dial 2021; 26:601-612. [PMID: 34505350 DOI: 10.1111/1744-9987.13732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/24/2021] [Accepted: 09/07/2021] [Indexed: 01/14/2023]
Abstract
Cardiovascular disease is the leading cause of mortality in patients with end-stage-kidney disease. Evidence on the possible echocardiographic differences between hemodialysis and peritoneal dialysis (PD) is scarce. This study aimed to evaluate differences in left (LA) and right atrial (RA), left (LV) and right ventricular (RV) geometry, systolic and diastolic function in hemodialysis, and PD patients. Thirty-eight hemodialysis and 38 PD patients were matched for age, sex, and dialysis vintage. Two-dimensional and tissue-Doppler echocardiography, and lung ultrasound were performed during an interdialytic day in hemodialysis and before a programmed follow-up visit in PD patients. Vena cava diameter (11.09 ± 4.53 vs. 14.91 ± 4.30 mm; p < 0.001) was significantly lower in hemodialysis patients. Indices of LA, RA, LV, and RV dimensions were similar between the two groups. LVMi (116.91 [38.56] vs. 122.83 [52.33] g/m2 ; p = 0.767) was similar, but relative wall thickness was marginally (0.40 [0.14] vs. 0.45 [0.15] cm; p = 0.055) lower in hemodialysis patients. LV hypertrophy prevalence was similar between groups (73.7% vs. 71.1%; p = 0.798), but hemodialysis patients presented eccentric and PD patients concentric LVH. Regarding ventricular systolic function, stroke volume (p = 0.030) and cardiac output (p = 0.036) were higher in hemodialysis, while RV systolic pressure (RVSP) (20.37 [22.54] vs. 27.68 [14.32] mm Hg; p = 0.009) was higher in PD. No significant differences were evidenced in diastolic function indices and lung water excess between the two groups. A moderate association was noted between ultrasound B-lines score and LA volume index (r = 0.465, p < 0.001), RVSP (r = 0.431, p < 0.001), and E/e' ratio (r = 0.304, p = 0.009). Hemodialysis and PD patients present largely similar echocardiographic indices reflecting cardiac geometry, systolic, and diastolic function, but different patterns of abnormal LV remodeling.
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Affiliation(s)
- Maria-Eleni Alexandrou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Department of Nephrology, Papageorgiou Hospital, Thessaloniki, Greece
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Μarieta P Theodorakopoulou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Christodoulos Papadopoulos
- 3rd Department of Cardiology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Charalampos Loutradis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasileios Kamperidis
- 1st Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aristi Boulmpou
- 3rd Department of Cardiology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitra-Rafailia Bakaloudi
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Danai Faitatzidou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Aikaterini Papagianni
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Quennelle S, Ovaert C, Cailliez M, Garaix F, Tsimaratos M, El Louali F. Dilatation of the aorta in children with advanced chronic kidney disease. Pediatr Nephrol 2021; 36:1825-1831. [PMID: 33459933 DOI: 10.1007/s00467-020-04887-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 10/27/2020] [Accepted: 12/01/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND The peculiarity of the cardiovascular risk profile with increased arterial vulnerability is well known in adults with chronic kidney disease (CKD). It is explained by an increased incidence of traditional cardiovascular risk factors together with other comorbidities related to the uremic condition and cardiorenal syndrome (CRS). The present study aimed to determine the cardiovascular impact of the uremic condition in a pediatric population with advanced CKD. METHODS From 2016 to 2018, 39 consecutive patients with advanced CKD who underwent echocardiographic evaluation were included. All echocardiographic examinations were performed by the same operator (FE). Demographic, clinical, biological, and echocardiographic data were collected. RESULTS The mean age at echocardiographic exam was 9.7 ± 4.6 years. Twenty-four (61.5%) patients were on hemodialysis; 17 (43.6%) patients were in a peritoneal dialysis program of whom 11 switched at a later stage to hemodialysis. Eight (20.5%) patients had an arteriovenous fistula (AVF). Hypertension was present in 30 (76.9%) patients while left ventricular hypertrophy (LVH) was described in 13 (33.3%) patients. Dilatation of the ascending aorta (Z-score > 2) was found in 15 (38.4%) patients and was statistically (in univariate analysis) related to gender, hypertension, the presence of an AVF, and the use of hemodialysis after peritoneal dialysis (p = 0.024, p = 0.016, p = 0.006, p = 0.009, respectively). CONCLUSION In addition to classical and predictable abnormalities related to CKD, we found a high prevalence of dilatation of the ascending aorta in children with advanced CKD. Hypertension, AVF, and hemodialysis were associated factors.
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Affiliation(s)
- Sophie Quennelle
- Paediatric Cardiology Department, La Timone Hospital, Aix-Marseille University, Marseille, France
| | - Caroline Ovaert
- Paediatric Cardiology Department, La Timone Hospital, Aix-Marseille University, Marseille, France
| | - Mathilde Cailliez
- Nephrology Unit, Pédiatrie Multidisciplinaire Timone, la Timone Hospital, Aix-Marseille University, Marseille, France
| | - Florentine Garaix
- Nephrology Unit, Pédiatrie Multidisciplinaire Timone, la Timone Hospital, Aix-Marseille University, Marseille, France
| | - Michel Tsimaratos
- Nephrology Unit, Pédiatrie Multidisciplinaire Timone, la Timone Hospital, Aix-Marseille University, Marseille, France
| | - Fedoua El Louali
- Paediatric Cardiology Department, La Timone Hospital, Aix-Marseille University, Marseille, France.
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Valerianova A, Malik J, Janeckova J, Kovarova L, Tuka V, Trachta P, Lachmanova J, Hladinova Z, Hruskova Z, Tesar V. Reduction of arteriovenous access blood flow leads to biventricular unloading in haemodialysis patients. Int J Cardiol 2021; 334:148-153. [PMID: 33895210 DOI: 10.1016/j.ijcard.2021.04.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 04/04/2021] [Accepted: 04/16/2021] [Indexed: 12/28/2022]
Abstract
AIMS Patients on chronic haemodialysis have a wide range of changes in cardiac function and structure, including left ventricular hypertrophy, dilation and diastolic dysfunction or pulmonary hypertension. All these changes were linked to increased mortality in previous studies. High-flow arteriovenous fistulas (AVF) are supposed to be a factor contributing to their development. This study investigated the early effect of surgical AVF blood flow (Qa) reduction on these changes in patients with or without heart failure changes. METHODS AND RESULTS Forty-two patients in chronic haemodialysis programme with high-flow AVF (Qa over 1500 mL/min), indicated for surgery for ≥1 of the following indications: 1.manifest heart failure; 2.hand ischemia; 3.advanced structural heart changes detected by echocardiography. The patients underwent echocardiography on selection visit, before blood flow reducing surgery and six weeks thereafter. The Qa reduction led to decrease of left ventricular mass (p = 0.02), end-diastolic volume (p = 0.008), end-diastolic diameter (p = 0.003) and left atrial volume (p = 0.0006). Diastolic function improved. Similarly, right ventricular diameter and right atrial volume decreased (p = 0.000001 and 0.00009, respectively) together with the decrease of estimated pulmonary artery systolic pressure. 81% of patients suffered from pulmonary hypertension prior to surgery, only 36% thereafter. CONCLUSION The surgical restriction of the hyperkinetic circulation leads to several improvements of heart structure and function, which was linked to higher mortality in other studies. The beneficial effect of Qa reduction is present even in patients without symptoms of heart failure. The contribution of AVF must be considered with structural or functional heart changes.
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Affiliation(s)
- Anna Valerianova
- 3(rd) Department of Internal Medicine, 1(st) Faculty of Medicine, Charles University, General University Hospital in Prague, U Nemocnice 1, 128 08 Prague, Czech Republic.
| | - Jan Malik
- 3(rd) Department of Internal Medicine, 1(st) Faculty of Medicine, Charles University, General University Hospital in Prague, U Nemocnice 1, 128 08 Prague, Czech Republic
| | - Jana Janeckova
- II. Department of Surgery, University Hospital in Olomouc, I.P. Pavlova 185/6, 779 00 Olomouc, Czech Republic
| | - Lucie Kovarova
- 3(rd) Department of Internal Medicine, 1(st) Faculty of Medicine, Charles University, General University Hospital in Prague, U Nemocnice 1, 128 08 Prague, Czech Republic
| | - Vladimir Tuka
- 3(rd) Department of Internal Medicine, 1(st) Faculty of Medicine, Charles University, General University Hospital in Prague, U Nemocnice 1, 128 08 Prague, Czech Republic
| | - Pavel Trachta
- 3(rd) Department of Internal Medicine, 1(st) Faculty of Medicine, Charles University, General University Hospital in Prague, U Nemocnice 1, 128 08 Prague, Czech Republic
| | - Jana Lachmanova
- Department of Nephrology, 1(st) Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 08 Prague, Czech Republic
| | - Zuzana Hladinova
- Department of Nephrology, 1(st) Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 08 Prague, Czech Republic
| | - Zdenka Hruskova
- Department of Nephrology, 1(st) Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 08 Prague, Czech Republic
| | - Vladimir Tesar
- Department of Nephrology, 1(st) Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 08 Prague, Czech Republic
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Moustafa BH, Badr A, Selim A, Samy R, Gamal N. Apolipoprotein E and plasminogen activator inhibitor 1 gene polymorphism in children with chronic renal insufficiency associated with cardiovascular disease. Egypt Pediatric Association Gaz 2019. [DOI: 10.1186/s43054-019-0011-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Cardiovascular disease (CVD) is considered a major cause of death in renal insufficiency (RI). Contributing genetic factors is a recent focus of research. This study aims to elucidate apolipoprotein E (APO-E) and plasminogen activator inhibitor 1 (PAI-1) gene polymorphisms in RI children associated with CVD.
Methods
We studied 50 cases with chronic kidney disease (CKD) associated with CVD, and 30 healthy controls. Study sample was grouped as one on conservative treatment, the second on hemodialysis and the third was posttransplant. PAI-1 and APO-E gene polymorphisms were investigated using allele-specific polymerase chain reaction (AS-PCR) and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) respectively.
Results
4G4G and 4G5G were the most common PAI-1 polymorphism denoting high association of 4 G allele in renal insufficiency associated with CVD with absent link to dyslipidemia, echocardiography changes or thrombosis. E3E3 was the most common among APO-E polymorphism without relation to dyslipidemia or thrombosis. Dyslipidemia was significantly linked to thrombosis. The study confirmed the role of dyslipidemia and hemodialysis in promoting thrombosis.
Conclusion
Although PAI 4G Genotyping did not show significant association with echocardiography severity or thrombotic severity, yet genetic expression for high levels of PAI in plasma is expected in response to CRI factors known to trigger its release, in addition to those related to dialysis. APO-E3E3 genotyping showed a significant association with echocardiography severity as it enhances APO-A which contributes to CVD. The current study confirmed a significant association between dyslipidemia and CVD; however, the prevalent patterns 4G and E3E3 did not show a significant association with dyslipidemia. The genetic role for APO-A, B, O, or even other isomers for APO-E should be further studied as well.
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12
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Dimitrijevic ZM, Salinger Martinovic SS, Nikolic VN, Cvetkovic TP. Protein Carbonyl Content Is a Predictive Biomarker of Eccentric Left Ventricular Hypertrophy in Hemodialysis Patients. Diagnostics (Basel) 2019; 9:E202. [PMID: 31775390 DOI: 10.3390/diagnostics9040202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/11/2019] [Accepted: 11/22/2019] [Indexed: 12/17/2022] Open
Abstract
High prevalence of left ventricular hypertrophy (LVH) and elevated oxidative stress are associated with poor outcomes in chronic hemodialysis patients. Abnormal left ventriculаr geomеtry and different geometric patterns play an important role as well. Our study analyzed the role of oxidative stress on myocardial remodeling in these patients. Plasma malondialdehyde (MDA), protein carbonyl (PC) content, and total antioxidative capacity (TAC) were investigated in 104 hemodialysis patients together with transthoracic echocardiography. Compared to patients with normal ventricular geometry, patients with LVH had increased MDA and PC plasma concentration. Multivariate analysis demonstrated that protein carbonyls, as biomarkers of oxidative protein modification, were an independent predictor of eccentric hypertrophy (eLVH), including higher LV end-diastolic diameter and LV end-diastolic volume, (β = 0.32 and β = 0.28, p < 0.001 for both). The incidence of eLVH increased progressively from the lowest to the highest baseline PC tertile (p < 0.001 for the trend) and the subjects in the former group showed a 76% greater risk of developing eLVH compared to their counterparts. After further adjustment for the potential mediators, PCs carried eLVH odds (95% confidence interval (CI)) of 1.256 (0.998-1.514), per standard deviation increase. High plasma protein carbonyls levels are a significant independent predictor of eccentric LVH in chronic hemodialysis patients.
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13
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Kalçık M, Yetim M, Doğan T, Eser B, Doğan İ, Bekar L, Çelik O, Karavelioğlu Y. The relationship between R wave peak time and left ventricular mass index in patients with end-stage renal disease on hemodialysis. Int Urol Nephrol 2019; 51:2045-53. [PMID: 31571157 DOI: 10.1007/s11255-019-02297-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 09/23/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Cardiovascular complications have been reported to be the main cause of mortality in patients with end-stage renal disease (ESRD). Although left ventricular hypertrophy is the most common clinical presentation of cardiac remodeling, cardiovascular complications may also include disturbances of the heart conduction system. The R wave peak time (RWPT) has been previously associated with left ventricular hypertrophy and myocardial ischemia. In this study, we aimed to investigate the relationship between RWPT and echocardiographic parameters in patients with ESRD. METHODS This study enrolled 66 patients (29 females, age 57.2 ± 12.8 years) with ESRD, and 72 controls (37 females, age 55.3 ± 10.1 years) with similar risk factors. All patients underwent electrocardiography and transthoracic echocardiography. The RWPT was defined as the interval between the onset of the QRS complex and the peak of the R or R' wave. RESULTS There was no significant difference in terms of clinical and demographic parameters between ESRD patients and controls. Left ventricular ejection fraction was similar between the groups. However, left atrial diameter, interventricular septal thickness, posterior wall thickness, left ventricular mass (LVM) and left ventricular mass index (LVMI) were significantly higher in patients with ESRD. Among electrocardiographic parameters, P wave and QRS complex durations and RWPT were significantly higher in patients with ESRD. Prolonged RWPT, increased LVM and LVMI were identified as associates of ESRD. Furthermore, RWPT correlated well with LVM and LVMI. CONCLUSION The present study demonstrated that RWPT prolonged significantly in patients with ESRD. Furthermore, prolonged RWPT has been associated with increased LVM and LVMI.
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14
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Ersbøll M, Raja AA, Warming PE, Nielsen TL, Plesner LL, Dalsgaard M, Schou M, Rydahl C, Brandi L, Iversen K. Changes in left ventricular filling parameters before and after dialysis in patients with end stage renal disease. Int J Cardiovasc Imaging 2019; 35:1673-81. [PMID: 31093896 DOI: 10.1007/s10554-019-01619-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 05/06/2019] [Indexed: 10/26/2022]
Abstract
The aim of this study was to investigate the grading of diastolic dysfunction (DD) in relation to hemodialysis in patients with end stage renal disease (ESRD) on hemodialysis (HD) Cardiovascular disease is prevalent in patients with ESRD and accounts for significant morbidity and mortality. Left ventricular hypertrophy (LVH) is common in ESRD but little is known about the impact of HD on currently recommended grading schemes for DD. Comprehensive echocardiographic data was obtained in consecutive patients with ESRD before (n = 247) and immediately after (n = 239) standard HD regimen. Grading of DD was performed according to current recommendations both pre- and post HD. Prior to HD, DD was classified as present in 83 patients (34%), indeterminate in 51 patients (21%) and absent in 113 patients (45%). Patients with DD at baseline compared to those without were older [67.3 years (13.1) vs. 63.2 (14.3), p = 0.037], were more likely to have diabetic- or hypertensive ESRD (43.4% vs. 35.4%, p = ns) and LVMi was significantly higher [119 g/cm2 (27.5) vs. 103 g/cm2 (24.3), p < 0.001]. After HD [mean HD time = 221 min (27.6), mean ultrafiltration volume = 2 L (1.1)], 39 patients (16%) exhibited sustained DD. These patients were older [69.4 years (14.5) vs. 65.0 years (13.9), p = 0.071], were more likely to have diabetic- or hypertensive ESRD (59% vs. 36%, p = 0.010). Myocardial adverse remodeling was more advanced with higher LVMi [127.4 g/m2 (27.5) vs. 106.5 g/m2 (25.3), p < 0.001], lower LVEF [44.7% (11.0) vs. 54.5% (8.7), p < 0.001] and more impaired GLS [- 13.4% (4.3) vs. - 15.8% (4.0), p = 0.006]. Echocardiographic evaluation of diastolic function in patients with ESRD on HD is critically dependent on timing relative to dialysis. The presence of sustained DD after volume unloading by HD identifies a population of patients with an adverse phenotype of blunted vascular response and severe cardiac remodeling.
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Abstract
Renal transplantation is the preferred treatment for patients with end-stage kidney disease. However, despite successful kidney transplantation, cardiovascular disease (CVD) remains one of the major causes of patient death and hence graft loss. The antecedents of this increased risk reside within the development of end-stage kidney disease and dialysis. Risk factors for the development of CVD include diabetes, hypertension, and dyslipidemia. Other transplant-specific factors include the presence of a patent arteriovenous fistula and immunosuppressive therapy. Efforts to modify these factors should be strongly encouraged to improve long-term outcomes of transplant patients and reduce death from CVD in this at-risk patient population.
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Affiliation(s)
- Nitesh N Rao
- Renal Unit, Lyell McEwin Hospital, Elizabeth Vale, South Australia
| | - P Toby Coates
- Renal Unit, Lyell McEwin Hospital, Elizabeth Vale, South Australia; Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia.
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16
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Rangaswami J, McCullough PA. Heart Failure in End-Stage Kidney Disease: Pathophysiology, Diagnosis, and Therapeutic Strategies. Semin Nephrol 2018; 38:600-617. [DOI: 10.1016/j.semnephrol.2018.08.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Abstract
PURPOSE OF REVIEW Volume management in hemodialysis patients is often challenging. Assessing volume status and deciding how much fluid to remove during hemodialysis, the so-called ultrafiltration rate (UFR), has remained a conundrum. RECENT FINDINGS To date there is no objective assessment tool to determine the needed UFR during each hemodialysis session. Higher volume overload or higher UFR is associated with poor outcomes including worse mortality and unfavorable clinical outcomes. We suggest combined use of the following criteria to determine UFR or post-dialysis target dry weight: pre-hemodialysis blood pressure and its intradialytic changes, muscle cramps, dyspnea from pulmonary vascular congestion, peripheral edema, tachycardia or palpitation, headache or lightheadedness, perspiration, and post-dialysis fatigue. Restricting fluid and salt intake-and high-dose loop diuretic use in cases of residual kidney function-can be helpful in controlling fluid gains. More frequent and more severe hypotensive episodes are associated with poor outcomes including higher death risk.
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Affiliation(s)
- Jason A Chou
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA
- Division of Nephrology, Department of Medicine, University of California, Irvine, School of Medicine, Orange, CA, USA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA.
- Division of Nephrology, Department of Medicine, University of California, Irvine, School of Medicine, Orange, CA, USA.
- Fielding School of Public Health at UCLA, Los Angeles, CA, USA.
- Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA, USA.
- Harold Simmons Center for Kidney Disease Research & Epidemiology, Division of Nephrology & Hypertension, University of California Irvine, School of Medicine, 101 The City Drive South, City Tower, Suite 400-ZOT: 4088, Orange, CA, 92868-3217, USA.
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18
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Feniman De Stefano GMM, Zanati-Basan SG, De Stefano LM, Silva VROE, Xavier PS, Barretti P, da Silva Franco RJ, Caramori JCT, Martin LC. Aldosterone is associated with left ventricular hypertrophy in hemodialysis patients. Ther Adv Cardiovasc Dis 2016; 10:304-13. [PMID: 27122492 PMCID: PMC5933569 DOI: 10.1177/1753944716644583] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Patients with chronic kidney disease present a higher degree of left ventricular hypertrophy than expected for hypertension levels. In chronic kidney disease the plot between the quotient extracellular water/total body water and aldosterone is shifted up and to the right. There are few studies that verified the role of aldosterone in cardiac remodeling in this set of patients. The aim of this study was to evaluate the relationship between serum aldosterone and left ventricular mass index in patients with chronic kidney disease on hemodialysis. METHODS The patients were submitted to clinical and laboratory evaluation, bioelectrical impedance, echocardiography and ambulatory blood pressure monitoring. The 27 patients included were divided into two groups according to aldosterone level and compared with each other. RESULTS The group of patients with higher aldosterone levels had higher left ventricular mass index. These groups were heterogeneous with regard to ambulatory systolic blood pressure, body mass index, and aldosterone levels and homogeneous with regard to the quotient extracellular water/total body water, renin-angiotensin-aldosterone system blockers, beta blocker use and other clinical characteristics. The association between aldosterone levels and left ventricular mass index was adjusted to confounding variables by a multiple linear regression analysis in which aldosterone was independently associated with left ventricular mass index. CONCLUSION The data presented are consistent with a pathogenic role of aldosterone in left ventricular hypertrophy in patients with chronic kidney dialysis in dialysis patients. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01128101.
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Affiliation(s)
- Greicy Mara Mengue Feniman De Stefano
- Departamento de Clínica Médica da Faculdade de Medicina de Botucatu - UNESP, Curso de Farmácia da Faculdade Sudoeste Paulista - FSP, Rua João Miguel Rafael. 440, CEP 18602-220 - Botucatu - SP, Brazil
| | | | | | | | - Patrícia Santi Xavier
- Departamento de Clínica Médica da Faculdade de Medicina de Botucatu - UNESP, Botucatu - SP, Brazil
| | - Pasqual Barretti
- Departamento de Clínica Médica da Faculdade de Medicina de Botucatu - UNESP, Botucatu - SP, Brazil
| | | | | | - Luis Cuadrado Martin
- Departamento de Clínica Médica da Faculdade de Medicina de Botucatu - UNESP, Botucatu - SP, Brazil
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Affiliation(s)
- Nitesh N. Rao
- Department of Renal Medicine; Royal Adelaide Hospital; Adelaide South Australia Australia
- University of Adelaide; Adelaide South Australia Australia
| | - Benjamin K. Dundon
- Monash Cardiovascular Research Centre; Monash HEART; Monash Health; Melbourne Victoria Australia
| | - Matthew I. Worthley
- Cardiovascular Research Centre at the Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Randall J. Faull
- Department of Renal Medicine; Royal Adelaide Hospital; Adelaide South Australia Australia
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20
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Koycheva RY, Cholakov V, Andreev J, Penev M, Iliev R, Nancheva K, Tsoneva V. Cardiac Biomarkers and Left Ventricular Hypertrophy in Asymptomatic Hemodialysis Patients. Open Access Maced J Med Sci 2015; 4:59-64. [PMID: 27275331 PMCID: PMC4884254 DOI: 10.3889/oamjms.2016.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 10/27/2015] [Accepted: 12/02/2015] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND: Cardiac biomarkers are often elevated in dialysis patients showing the presence of left ventricular dysfunction. The aim of the study is to establish the plasma levels of high-sensitivity cardiac troponin T (hs TnT), precursor of B-natriuretic peptide (NT-proBNP) and high sensitivity C-reactive protein (hs CRP) and their relation to the presence of left ventricular hypertrophy (LVH) in patients undergoing hemodialysis without signs of acute coronary syndrome or heart failure. MATERIAL AND METHODS: We studied 48 patients - 26 men and 22 women. Pre and postdialysis levels of hs cTnT, NT-proBNP and hs CRP were measured at week interim procedure. Patients were divided in two groups according to the presence of echocardiographic evidence of LVH - gr A - 40 patients (with LVH), and gr B - 8 patients (without LVH). RESULTS: In the whole group of patients was found elevated predialysis levels of all three biomarkers with significant increase (p < 0.05) after dialysis with low-flux dialyzers. Predialysis values of NT-proBNP show moderate positive correlation with hs cTnT (r = 0.47) and weaker with hs CRP (r = 0.163). Such dependence is observed in postdialysis values of these biomarkers. There is a strong positive correlation between the pre and postdialysis levels: for hs cTnT (r = 0.966), for NT-proBNP (r = 0.918) and for hs CRP (r = 0.859). It was found a significant difference in the mean values of hs cTnT in gr. A and gr. B (0.07 ± 0.01 versus 0.03 ± 0.01 ng/mL, p < 0.05) and NT-proBNP (15,605.8 ± 2,072.5 versus 2,745.5 ± 533.55 pg/mL, p < 0.05). Not find a significant difference in hs CRP in both groups. CONCLUSIONS: The results indicate the relationship of the studied cardiac biomarkers with LVH in asymptomatic patients undergoing hemodialysis treatment.
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Affiliation(s)
- Reneta Yovcheva Koycheva
- Department of Nephrology, University Hospital "Prof. Dr. Stoyan Kirkovich", Stara Zagora, Bulgaria
| | - Vasil Cholakov
- Department of Nephrology, University Hospital "Prof. Dr. Stoyan Kirkovich", Stara Zagora, Bulgaria
| | - Jivko Andreev
- Department of Nephrology, University Hospital "Prof. Dr. Stoyan Kirkovich", Stara Zagora, Bulgaria
| | - Margarit Penev
- Department of Nephrology, University Hospital "Prof. Dr. Stoyan Kirkovich", Stara Zagora, Bulgaria
| | - Rosen Iliev
- Department of Nephrology, University Hospital "Prof. Dr. Stoyan Kirkovich", Stara Zagora, Bulgaria
| | - Krasimira Nancheva
- Department of Nephrology, University Hospital "Prof. Dr. Stoyan Kirkovich", Stara Zagora, Bulgaria
| | - Vanya Tsoneva
- Department of Nephrology, University Hospital "Prof. Dr. Stoyan Kirkovich", Stara Zagora, Bulgaria
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Di Lullo L, Gorini A, Russo D, Santoboni A, Ronco C. Left Ventricular Hypertrophy in Chronic Kidney Disease Patients: From Pathophysiology to Treatment. Cardiorenal Med 2015; 5:254-66. [PMID: 26648942 DOI: 10.1159/000435838] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Cardiovascular diseases represent the main causes of morbidity and mortality in patients with chronic kidney disease (CKD). According to a well-established classification, cardiovascular involvement in CKD can be set in the context of cardiorenal syndrome type 4. Left ventricular hypertrophy (LVH) represents a key feature to provide an accurate picture of systolic-diastolic left heart involvement in CKD patients. Cardiovascular involvement is present in about 80% of prevalent hemodialysis patients, and it is evident in CKD patients since stage IIIb-IV renal disease (according to the K/DOQI CKD classification). According to the definition of cardiorenal syndrome type 4, kidney disease is detected before the development of heart failure, although timing of the diagnosis is not always possible. The evaluation of LVH is a bit heterogeneous, and few standard imaging methods can provide the accuracy of either CT- or MRI-derived left ventricular mass. Key principles in the treatment of LVH in CKD patients are mainly based on anemia and blood pressure control, together with the management of secondary hyperparathyroidism and sudden cardiac death prevention. This review is mainly focused on the clinical aspects of CKD-related LVH to provide practical guidelines both for cardiologists and nephrologists in the daily clinical approach to CKD patients.
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Affiliation(s)
- Luca Di Lullo
- Department of Nephrology and Dialysis, L. Parodi Delfino Hospital, Colleferro, Italy
| | - Antonio Gorini
- Department of Nephrology and Dialysis, L. Parodi Delfino Hospital, Colleferro, Italy
| | - Domenico Russo
- Division of Nephrology, University of Naples Federico II, Naples, Italy
| | - Alberto Santoboni
- Department of Nephrology and Dialysis, L. Parodi Delfino Hospital, Colleferro, Italy
| | - Claudio Ronco
- International Renal Research Institute, S. Bortolo Hospital, Vicenza, Italy
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Feniman-De-Stefano GMM, Zanati-Basan SG, De Stefano LM, Xavier PS, Castro AD, Caramori JCT, Barretti P, Franco RJDS, Martin LC. Spironolactone is secure and reduces left ventricular hypertrophy in hemodialysis patients. Ther Adv Cardiovasc Dis 2015; 9:158-67. [PMID: 26116627 DOI: 10.1177/1753944715591448] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES There is recent evidence that aldosterone play a role in the pathogenesis of cardiovascular disease in dialysis patients, which leads to the opportunity to block its actions for the benefit of these patients. In nondialytic chronic kidney disease, spironolactone was safe and effective in reducing left ventricular hypertrophy. However, routine use has been precluded in hemodialysis patients due to the risk of hyperkalemia. The aim of this study is to verify the safety and efficacy in regression of left ventricular hypertrophy with spironolactone in hemodialysis patients undergoing pharmacotherapeutic monitoring. METHODS We performed a controlled, randomized, double blind study evaluating 17 hemodialysis patients who received spironolactone at a dose of 12.5 mg titrated, in the second week, to 25 mg of spironolactone or placebo. The patients were treated for 6 months. RESULTS The groups were composed of eight patients (intervention) and nine patients (control). These groups did not differ in their baseline characteristics. The group receiving spironolactone had a left ventricular mass index reduction from 77 ± 14.6 g/m(2.7) to 69 ± 10.5 g/m(2.7), p < 0.04, whereas in placebo group there was an increase from 71 ± 14.2 g/m(2.7) to 74 ± 17.4 g/m(2.7). Systolic or diastolic blood pressure did not change during the study. Potassium did not differ statistically between groups in all instances. CONCLUSION Spironolactone treatment in hemodialysis patients was secure and effective in regression of left ventricular hypertrophy, a major risk factor for cardiovascular events in these patients. This effect occurred in spite of blood pressure stability. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT01128101.
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Affiliation(s)
| | | | | | | | - Ana Dóris Castro
- Dpto de Medicamentos - Faculdade de Ciências Farmacêuticas - UNESP, Brazil
| | | | - Pasqual Barretti
- Dpto de Clínica Médica da Faculdade de Medicina de Botucatu - UNESP, Brazil
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Lai S, Molfino A, Russo GE, Testorio M, Galani A, Innico G, Frassetti N, Pistolesi V, Morabito S, Rossi Fanelli F. Cardiac, Inflammatory and Metabolic Parameters: Hemodialysis versus Peritoneal Dialysis. Cardiorenal Med 2014; 5:20-30. [PMID: 25759697 DOI: 10.1159/000369588] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 11/04/2014] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Mortality in dialysis patients is higher than in the general population, and cardiovascular disease represents the leading cause of death. Hypertension and volume overload are important risk factors for the development of left ventricular hypertrophy (LVH) in hemodialysis (HD) and peritoneal dialysis (PD) patients. Other factors are mainly represented by hyperparathyroidism, vascular calcification, arterial stiffness and inflammation. The aim of this study was to compare blood pressure (BP) and metabolic parameters with cardiovascular changes [cardiothoracic ratio (CTR), aortic arch calcification (AAC) and LV mass index (LVMI)] between PD and HD patients. MATERIALS AND METHODS 45 patients (23 HD and 22 PD patients) were enrolled. BP measurements, echocardiography and chest X-ray were performed in each patient to determine the LVMI and to evaluate the CTR and AAC. Inflammatory indexes, intact parathyroid hormone (iPTH) and arterial blood gas analysis were also evaluated. RESULTS LVMI was higher in PD than HD patients (139 ŷ 19 vs. 104 ŷ 22; p = 0.04). In PD patients, a significant correlation between iPTH, C-reactive protein and the presence of LVH was observed (r = 0.70, p = 0.04; r = 0.70, p = 0.03, respectively). The CTR was increased in PD patients as compared to HD patients, while no significant differences in cardiac calcifications were determined. CONCLUSIONS Our data indicate that HD patients present more effective BP control than PD patients. Adequate fluid and metabolic control are necessary to assess the adequacy of BP, which is strongly correlated with the increase in LVMI and with the increased CTR in dialysis patients. PD is a home therapy and allows a better quality of life, but PD patients may present a further increased cardiovascular risk if not adequately monitored.
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Affiliation(s)
- Silvia Lai
- Department of Clinical Medicine, Hemodialysis Unit, Umberto I, Polyclinic of Rome, Sapienza University of Rome, Rome, Italy
| | - Alessio Molfino
- Department of Clinical Medicine, Hemodialysis Unit, Umberto I, Polyclinic of Rome, Sapienza University of Rome, Rome, Italy
| | - Gaspare Elios Russo
- Department of Gynecology, Obstetrics and Urological Sciences, Hemodialysis Unit, Umberto I, Polyclinic of Rome, Sapienza University of Rome, Rome, Italy
| | - Massimo Testorio
- Department of Gynecology, Obstetrics and Urological Sciences, Hemodialysis Unit, Umberto I, Polyclinic of Rome, Sapienza University of Rome, Rome, Italy
| | - Alessandro Galani
- Department of Clinical Medicine, Hemodialysis Unit, Umberto I, Polyclinic of Rome, Sapienza University of Rome, Rome, Italy
| | - Georgie Innico
- Department of Gynecology, Obstetrics and Urological Sciences, Hemodialysis Unit, Umberto I, Polyclinic of Rome, Sapienza University of Rome, Rome, Italy
| | - Nicla Frassetti
- Department of Clinical Medicine, Hemodialysis Unit, Umberto I, Polyclinic of Rome, Sapienza University of Rome, Rome, Italy
| | - Valentina Pistolesi
- Department of Nephrology and Urology, Hemodialysis Unit, Umberto I, Polyclinic of Rome, Sapienza University of Rome, Rome, Italy
| | - Santo Morabito
- Department of Nephrology and Urology, Hemodialysis Unit, Umberto I, Polyclinic of Rome, Sapienza University of Rome, Rome, Italy
| | - Filippo Rossi Fanelli
- Department of Clinical Medicine, Hemodialysis Unit, Umberto I, Polyclinic of Rome, Sapienza University of Rome, Rome, Italy
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Oh G, Wong C, Begin B, Salsbery K, Sutherland S, Chaudhuri A. Whole-body single-frequency bioimpedance analysis in pediatric hemodialysis patients. Pediatr Nephrol 2014; 29:1417-23. [PMID: 24570069 DOI: 10.1007/s00467-014-2778-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 01/26/2014] [Accepted: 01/27/2014] [Indexed: 01/27/2023]
Abstract
BACKGROUND We hypothesized that the percent change in resistance (%RΔ) from bioimpedance analysis (BIA) measurements during hemodialysis (HD) can provide information on pediatric HD patients' hydration status. METHODS Whole-body single-frequency BIA measurements were obtained before HD, each hour on HD, and after HD during two HD sessions. Pre-and post-HD weights, blood pressures, Crit-Line® measurements, and intradialytic symptoms were collected on the day of the BIA measurements. RESULTS One hundred and thirty BIA measurements were obtained from 14 HD patients. The group was 43 % girls, and the mean age was 13.2 ± 4.4 years. Percent change in resistance was 13.5 ± 10.8 % at the end of HD; %RΔ correlated with percent body weight change (%BWΔ) following HD (r = -0.83, P < 0.01), as well as with percent blood volume change (%BVΔ) (r = -0.79, P < 0.01). The %RΔ was similar between patients with and without hypertension immediately before HD and was greater in those with intradialytic symptoms (19.1 ± 7.7 %) than in those without (9.9 ± 11.2 %) (P = 0.02). Patients with left ventricular hypertrophy (LVH) had lower %RΔ (7.2 ± 9.7 %) than those without (19.5 ± 7.7 %) (P = 0.03). Left ventricular mass index (LVMI) also correlated strongly with %RΔ (r = -0.79, P = 0.004) and %BWΔ (r = 0.82, P = 0.002). CONCLUSIONS Our study showed that %RΔ strongly correlates with %BWΔ and %BVΔ and that %RΔ also correlated with intradialytic symptoms and LVMI.
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Affiliation(s)
- Gia Oh
- Department of Pediatrics, Division of Nephrology, Stanford University, 300 Pasteur Drive, Room G306, Stanford, CA, 94305, USA,
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Demirci C, Ozkahya M, Demirci MS, Asci G, Kose T, Colak T, Duman S, Toz H, Ergin P, Adam SM, Ok E. Effects of three times weekly eight-hour nocturnal hemodialysis on volume and nutritional status. Am J Nephrol 2013; 37:559-67. [PMID: 23735837 DOI: 10.1159/000351182] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 04/01/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND This prospective cohort study compared the changes in body water composition and nutritional parameters measured with multifrequency bioimpedance analysis between 8-hour three times weekly nocturnal hemodialysis (NHD) and 4-hour conventional hemodialysis (CHD) patients. PATIENTS AND METHODS 55 patients on CHD and 57 patients on NHD were included in the study. Multifrequency bioimpedance analysis was performed at baseline and at the 12th month. The primary outcomes of the study were changes in extracellular water (ECW), fat mass, dry lean mass and phase angle. Secondary outcomes of the study included changes in blood pressure and biochemical parameters related to nutrition and inflammation. RESULTS ECW/height values decreased in the NHD group, while they increased in the CHD group. Fat mass, dry lean mass, and serum albumin increased and high sensitive CRP decreased in the NHD group but did not change in the CHD group. When changes in parameters from baseline to the 12th month between the groups were compared, NHD was associated with improvement in volume parameter including ECW/height (difference -0.44 l/m, p < 0.001). Change in blood pressure was not different between the groups, however requirement for antihypertensive medication decreased from 26.5 to 8.5% in the NHD group (p = 0.002). NHD was also associated with increases in fat mass (difference 1.8 kg, p < 0.001), dry lean mass (difference 0.6 kg, p = 0.006), serum albumin (difference 0.19 g/dl, p < 0.001) and cholesterol (difference 18.8 mg, p < 0.001). Phase angle values decreased in the CHD group but did not change in the NHD group (difference between the groups 0.37°, p = 0.04). CONCLUSION This study revealed that longer HD facilitates volume control and improves nutritional status.
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Affiliation(s)
- Cenk Demirci
- Division of Nephrology, Fresenius Medical Care Turkey Clinics, Izmir, Turkey.
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Kim SJ, Oh HJ, Yoo DE, Shin DH, Lee MJ, Kim HR, Park JT, Han SH, Yoo TH, Choi KH, Kang SW. Electrocardiographic left ventricular hypertrophy and outcome in hemodialysis patients. PLoS One 2012; 7:e35534. [PMID: 22530043 PMCID: PMC3328457 DOI: 10.1371/journal.pone.0035534] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 03/17/2012] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND AND AIMS Electrocardiography (ECG) is the most widely used initial screening test for the assessment of left ventricular hypertrophy (LVH), an independent predictor of cardiovascular mortality in patients with end-stage renal disease (ESRD). However, traditional ECG criteria based only on voltage to detect LVH have limited clinical utility for the detection of LVH because of their poor sensitivity. METHODS This prospective observational study was undertaken to compare the prognostic significance of commonly used ECG criteria for LVH, namely Sokolow-Lyon voltage (SV) or voltage-duration product (SP) and Cornell voltage (CV) or voltage-duration product (CP) criteria, and to investigate the association between echocardiographic LV mass index (LVMI) and ECG-LVH criteria in ESRD patients, who consecutively started maintenance hemodialysis (HD) between January 2006 and December 2008. RESULTS A total of 317 patients, who underwent both ECG and echocardiography, were included. Compared to SV and CV criteria, SP and CP criteria, respectively, correlated more closely with LVMI. In addition, CP criteria provided the highest positive predictive value for echocardiographic LVH. The 5-year cardiovascular survival rates were significantly lower in patients with ECG-LVH by each criterion. In multivariate analyses, echocardiographic LVH [adjusted hazard ratio (HR): 11.71; 95% confidence interval (CI): 1.57-87.18; P = 0.016] and ECG-LVH by SP (HR: 3.43; 95% CI: 1.32-8.92; P = 0.011) and CP (HR: 3.07; 95% CI: 1.16-8.11; P = 0.024) criteria, but not SV and CV criteria, were significantly associated with cardiovascular mortality. CONCLUSIONS The product of QRS voltage and duration is helpful in identifying the presence of LVH and predicting cardiovascular mortality in incident HD patients.
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Affiliation(s)
- Seung Jun Kim
- Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea
| | - Hyung Jung Oh
- Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea
| | - Dong Eun Yoo
- Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea
| | - Dong Ho Shin
- Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea
| | - Mi Jung Lee
- Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea
| | - Hyoung Rae Kim
- Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea
| | - Jung Tak Park
- Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea
| | - Seung Hyeok Han
- Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea
| | - Tae-Hyun Yoo
- Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea
| | - Kyu Hun Choi
- Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea
- Severance Biomedical Science Institute, Brain Korea 21, Yonsei University, Seoul, Korea
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Abstract
As dialytic practice has evolved, hemodialysis (HD) adequacy has come to be defined in terms of small molecule clearance. A growing body of evidence suggests that fluid dynamics, specifically ultrafiltration rate (UFR), bear clinical and physiological significance and should perhaps play a more central role in titrating HD therapy. Three recent studies have shown an independent association between higher UFR and mortality. Further work is needed to determine whether this relationship represents a direct toxic effect of rapid fluid perturbations or whether this association is a consequence of confounding on the basis of large interdialytic weight gain, as each would prompt a different therapeutic response. This mounting evidence builds the case that fluid management should play a more central role in the dialytic prescription and that more individualized approaches to fluid management should be encouraged.
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Affiliation(s)
- Jennifer E Flythe
- Renal Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Abstract
Patients receiving hemodialysis have high rates of cardiovascular morbidity and mortality that may be related to the hemodynamic effects of rapid ultrafiltration. Here we tested whether higher dialytic ultrafiltration rates are associated with greater all-cause and cardiovascular mortality, and hospitalization for cardiovascular disease. We used data from the Hemodialysis Study, an almost-7-year randomized clinical trial of 1846 patients receiving thrice-weekly chronic dialysis. The ultrafiltration rates were divided into three categories: up to 10 ml/h/kg, 10-13 ml/h/kg, and over 13 ml/h/kg. Compared to ultrafiltration rates in the lowest group, rates in the highest were significantly associated with increased all-cause and cardiovascular-related mortality with adjusted hazard ratios of 1.59 and 1.71, respectively. Overall, ultrafiltration rates between 10-13 ml/h/kg were not associated with all-cause or cardiovascular mortality; however, they were significantly associated among participants with congestive heart failure. Cubic spline interpolation suggested that the risk of all-cause and cardiovascular mortality began to increase at ultrafiltration rates over 10 ml/h/kg regardless of the status of congestive heart failure. Hence, higher ultrafiltration rates in hemodialysis patients are associated with a greater risk of all-cause and cardiovascular death.
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Affiliation(s)
- Jennifer E Flythe
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Tapolyai M, Fülöp T. Hypervolemic Hemorrhage after Dialysis Catheter Placement. J Vasc Access 2010; 11:173-4. [DOI: 10.1177/112972981001100219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Mihály Tapolyai
- Louisiana State University Health Sciences Center - Shreveport, Shreveport, LA - USA
- Overton Brooks Veterans' Administration Medical Center, Shreveport, LA - USA
| | - Tibor Fülöp
- University of Mississippi Medical Center, Jackson, MS - USA
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Abstract
Chronic kidney disease (CKD) and ESRD, treated with conventional hemo- or peritoneal dialysis are both associated with a high prevalence of an increase in left ventricular mass (left ventricular hypertrophy [LVH]), intermyocardial cell fibrosis, and capillary loss. Cardiac magnetic resonance imaging is the best way to detect and quantify these abnormalities, but M-Mode and 2-D echocardiography can also be used if one recognizes their pitfalls. The mechanisms underlying these abnormalities in CKD and ESRD are diverse but involve afterload (arterial pressure and compliance), preload (intravascular volume and anemia), and a wide variety of afterload/preload independent factors. The hemodynamic, metabolic, cellular, and molecular mediators of myocardial hypertrophy, fibrosis, apoptosis, and capillary degeneration are increasingly well understood. These abnormalities predispose to sudden cardiac death, most likely by promotion of electrical instability and re-entry arrhythmias and congestive heart failure. Current treatment modalities for CKD and ESRD, including thrice weekly conventional hemodialysis and peritoneal dialysis and metabolic and anemia management regimens, do not adequately prevent or correct these abnormalities. A new paradigm of therapy for CKD and ESRD that places prevention and reversal of LVH and cardiac fibrosis as a high priority is needed. This will require novel approaches to management and controlled interventional trials to provide evidence to fuel the transition from old to new treatment strategies. In the meantime, key management principles designed to ameliorate LVH and its complications should become a routine part of the care of the patients with CKD and ESRD.
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Affiliation(s)
- Richard J Glassock
- The David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
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Yen T, Lin J, Lin-tan D, Hsu K. Cardiothoracic Ratio, Inflammation, Malnutrition, and Mortality in Diabetes Patients on Maintenance Hemodialysis. Am J Med Sci 2009; 337:421-8. [PMID: 19525660 DOI: 10.1097/maj.0b013e31819bbec1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bossola M, Tazza L, Vulpio C, Luciani G. Reviews: Is Regression of Left Ventricular Hypertrophy in Maintenance Hemodialysis Patients Possible? Semin Dial 2008; 21:422-30. [DOI: 10.1111/j.1525-139x.2008.00471.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Indocyanine green (ICG) is a dye used to measure plasma volume and cardiac output and to assess hepatic function by monitoring the ICG plasma disappearance rate. A method for continuous and noninvasive measurement of ICG plasma concentration (c) in the extracorporeal circulation is presented using technology originally developed for on-line measurement of hematocrit. As expected from the ICG absorption maximum at 805 nm, the presence of ICG in blood leads to a pronounced increase in hematocrit (Hct) measured by optical means. This apparent change in hematocrit (Hct(rel) = Hct/ Hct(b) - 1) relative to the baseline hematocrit (Hct(b), where c = 0) showed a strong linear relationship (Hct(rel) = k.c) with respect to ICG concentration. The dependence of k on baseline hematocrit was best described by an exponential relationship (k = a*e(b*Hctb)). The constants a and b were determined in in vitro experiments using bovine blood. With the information on a and b, and when baseline hematocrit is known and can be assumed to remain constant throughout the observation phase, plasma ICG concentration can be noninvasively and continuously measured in the extracorporeal circulation by using available optical techniques without taking blood samples. This approach greatly simplifies the diagnostic use of ICG, which may be of importance in patients treated with extracorporeal blood purification techniques.
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Affiliation(s)
- Daniel Schneditz
- Institute of Physiology, Medical University of Graz, Graz, Austria
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Abstract
Natriuretic peptides are involved in the regulation of volume homeostasis. Their levels generally are increased in the setting of volume expansion and act on multiple effector systems to cause vasodilation and natriuresis in an effort to return volume status back to normal. In patients with end-stage renal disease, the natriuretic capabilities of these peptides are limited. However, there has been much interest in the potential applicability of measurement of these peptides as a surrogate marker of volume status and in the determination of dry weight. Furthermore, atrial natriuretic peptide and brain natriuretic peptide can serve as markers of left ventricular dysfunction and may have utility in determining cardiac prognosis in patients on long-term dialysis therapy.
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Affiliation(s)
- Sergei Joffy
- Department of Internal Medicine and Division of Nephrology, University of Virginia Health System, Charlottesville, VA 22903, USA
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