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Right ventricular dysfunction in patients with end-stage renal disease on regular hemodialysis
The Egyptian Journal of Internal Medicine volume 25, pages 127–132 (2013)
Abstract
Background
Although there are considerable data on the changes in left ventricular function in hemodialysis (HD) patients, only a few studies on right ventricular (RV) function can be found in the literature. We investigated the changes in RV function in HD patients.
Methods
We examined 74 individuals grouped as follows: healthy controls (n = 24) and HD patients (n = 50). Echocardiography including tissue Doppler imaging (TDI) of the RV was performed in all patients.
Results
HD patients had significantly lower RV systolic indices than control participants in right ventricle fractional area change (normal 35–63%) (37.54 ± 9.86 vs. 43.5± 4.8%, P<0.001), tricuspid plane systolic excursion (normal 1.6–3 cm) (2.09 ± 0.49 vs. 2.61± 0.36 cm, P<0.001), STDIS′ wave (7.99± 1.37 vs. 9.66± 1.86 cm/s, P<0.001), and LTDIS′ wave (peak systolic velocity at lateral tricuspid annulus; normal: 10–19 cm/s) (11.86 ± 2.86 vs.16.04 ±3.60, P<0.001). HD patients had statistically significantly higher systolic pulmonary pressure (normal<35mmHg at rest) compared with those in the control group (32.75 ± 10.11 vs. 25.23± 3.99, P<0.001). There were no statistically significant correlations between systolic pulmonary pressure and RV dimensions or RV function indices.
Conclusion
Subclinical RV dysfunction – as estimated by RV function indices; tricuspid plane systolic excursion, right ventricle fractional area change, and LTDIS′ – is increased among HD patients. A high prevalence of pulmonary hypertension was found among HD patients and this was not associated significantly with RV or left ventricular dysfunction in these patients.
References
No authors listed in this article. Causes of death. USRDS United States Renal Data System. Am J Kidney Dis 1997; 30: S107–S117.
Foley RN, Parfrey PS, Sarnak MJ. Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis 1998; 32 (Suppl 3): S112–S119.
FassbinderW, Brunner FP, Brynger H, Ehrich JHH, GeerlingsW, Raine AEG, et al. Combined report on regular dialysis and transplantation in Europe, XX, 1989. Nephrol Dial Transplant 1991; 6 (Suppl 1): 5–35.
Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, et al. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association councils on kidney in cardiovascular disease, high blood pressure research, clinical cardiology and epidemiology and prevention. Circulation 2003; 108: 2154–2169.
Stenvinkel P, Pecoits Filho R, Lindholm B. Coronary artery disease in endstage renal disease: no longer a simple plumbing problem. J Am Soc Nephrol 2003; 14: 1927–1939.
Parfrey PS, Foley RN. The clinical epidemiology of cardiac disease in chronic renal failure. J Am Soc Nephrol 1999; 10: 1606–1615.
Hutchinson TA, Thomas CD, Mac Gibbon B. Predicting survival in adults with end-stage renal failure: an age-equivalence index. Ann Intern Med 1982; 96: 417–423.
Collins AJ, Ma JZ, Umen A, Keshaviah P. Urea index and other predictors of hemodialysis patient survival. Am J Kidney Dis 1994; 23: 272–282.
Foley RN, Herzog CA, Collins AJ. Smoking and cardiovascular outcomes in dialysis patients: the United States renal data system wave 2 study. Kidney Int 2003; 63: 1462–1467.
Foley RN, Parfrey PS, Harnett JD, Kent GM, Martin CJ, Murray DC, et al. Clinical and echocardiographic disease in patients starting end-stage renal disease therapy. Kidney Int 1995; 47: 186–192.
No authors listed in this article. K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. Am J Kidney Dis 2005; 45 (Suppl 3): S1–S153.
Curtis BM, Parfrey PS. Congestive heart failure in chronic kidney disease: disease-specific mechanisms of systolic and diastolic heart failure and management. Cardiol Clin 2005; 23: 275–284.
Greaves SC, Sharpe DN. Cardiovascular disease in patients with end-stage renal failure. Aust N Z J Med 1992; 22: 153–159.
Paneni F, Gregori M, Ciavarella GM, Sciarretta S, De Biase L, Marino L, et al. Right ventricular dysfunction in patients with end-stage renal disease. Am J Nephrol 2010; 32: 432–438.
Sahn DJ, DeMaria A, Kisslo J, Weyman A. Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation 1978; 58: 1072–1083.
Teichholz LE, Kreulen T, Herman MV, Gorlin R. Problems in echocardiographic volume determinations: echocardiographic angiographic correlations in the presence or absence of asynergy. Am J Cardiol 1976; 37: 7–11.
Mohi Ud Din K, Bali HK, Banerjee S, Sakhuja V, Jha V. Silent myocardial ischemia and high-grade ventricular arrhythmias in patients on maintenance hemodialysis. Ren Fail 2005; 27: 171–175.
Trespalacios FC, Taylor AJ, Agodoa LY, Bakris GL, Abbott KC. Heart failure as a cause for hospitalization in chronic dialysis patients. Am J Kidney Dis 2003; 41: 1267–1277.
Gulel O, Soylu K, Yuksel S, Karaoglanoglu M, Cengiz K, Dilek M, et al. Evidence of left ventricular systolic and diastolic dysfunction by color tissue Doppler imaging despite normal ejection fraction in patients on chronic hemodialysis program. Echocardiography 2008; 25: 569–574.
Said K, Hassan M, Baligh E, Zayed B, Sorour K. Ventricular function in patients with end-stage renal disease starting dialysis therapy: a tissue Doppler imaging study. Echocardiography 2012; 29: 1054–1059.
Esquitin R, Razzouk L, Peterson GE, Wright JT Jr., Phillips RA, De Backer TL, et al. Left ventricular hypertrophy by electrocardiography and echocardiography in the African American Study of Kidney Disease Cohort Study. J Am Soc Hypertens 2012; 6: 193–200.
López Candales A, Dohi K, Rajagopalan N, Edelman K, Gulyasy B, Bazaz R. Defining normal variables of right ventricular size and function in pulmonary hypertension: an echocardiographic study. Postgrad Med J 2008; 84: 40–45.
Di Lullo L, Floccari F, Polito P. Right ventricular diastolic function in dialysis patients could be affected by vascular access. Nephron Clin Pract 2011; 118: c257–c261.
Anavekar NS, Gerson D, Skali H, Kwong RY, Kent Yucel E, Solomon SD. Two-dimensional assessment of right ventricular function: an echocardiographic- MRI correlative study. Echocardiography 2007; 24: 452–456.
Nakhoul F, Yigla M, Gilman R, Reisner SA, Abassi Z. The pathogenesis of pulmonary hypertension in haemodialysis patients via arterio-venous access. Nephrol Dial Transplant 2005; 20: 1686–1692.
Tarrass F, Benjelloun M, Medkouri G, Hachim K, Benghanem MG, Ramdani B. Doppler echocardiograph evaluation of pulmonary hypertension in patients undergoing hemodialysis. Hemodial Int 2006; 10: 356–359.
Abdelwhab S, Elshinnawy S. Pulmonary hypertension in chronic renal failure patients. Am J Nephrol 2008; 28: 990–997.
Amin M, Fawzy A, Hamid MA, Elhendy A. Pulmonary hypertension in patients with chronic renal failure: role of parathyroid hormone and pulmonary artery calcifications. Chest 2003; 124: 2093–2097.
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Momtaz, M., Fishawy, H.A., Aljarhi, U.M. et al. Right ventricular dysfunction in patients with end-stage renal disease on regular hemodialysis. Egypt J Intern Med 25, 127–132 (2013). https://doi.org/10.7123/01.EJIM.0000432302.99518.c5
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DOI: https://doi.org/10.7123/01.EJIM.0000432302.99518.c5