Cardiac function and structure in patients with chronic renal failure

Schärer, K; Schmidt, Klaus G.; Soergel, Marianne

doi:10.1007/s004670050737

Cited by 78 publications

(61 citation statements)

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“…Possible causes of right ventricular changes in patients undergoing HD may be uremia, fl uid retention, renal anemia, hyperparathyroidism, and high AV shunt fl ow [13][14][15]. Although RV works against low pressure in normal situations, it can adapt to high volume changes.…”

Section: Discussionmentioning

confidence: 99%

Echocardiographic assessment of right ventricular functions in nondiabetic normotensive hemodialysis patients

Karaveli̇oğlu

Özkurt

Kalçık

et al. 2015

IMAS

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Abstract:Purpose: Heart is aff ected structurally and functionally in end-stage renal disease (ESRD). However, the data available about adverse eff ects of ESRD on right ventricle (RV) is scarce. We aimed to evaluate echocardiographic parameters of RV in nondiabetic, normotensive patients with ESRD undergoing hemodialysis (HD). Methods: A total of 45 (24 women; mean age 52.4 ± 12.4 years) consecutive nondiabetic, normotensive patients with ESRD undergoing HD and 39 healthy age and sex-matched control subjects (22 women; mean age 50.3 ± 6.6 years) were enrolled in the study. M-mode and two dimensional images, color, pulsed and continuous wave Doppler, and tissue Doppler measurements were acquired from all subjects. Echocardiographic evaluation was performed in the days between HD dates of the patients. Results: RV fractional area change, tricuspid annular plane systolic excursion, tricuspid E velocity, E/A ratio, tricuspid annular E´ velocity, and E´/A´ ratio were lower in patients than controls (p < 0.001, p = 0.003, p = 0.007, p = 0.005, p < 0.001, and p = 0.034, respectively). However, RV diastolic area, RV myocardial performance index, E/E´ ratio, and mean and systolic pulmonary artery pressure were higher in patients than controls (p < 0.001, p = 0.007, p = 0.005, p < 0.001, p = 0.006, respectively). Conclusions: RV systolic and diastolic functions of nondiabetic, normotensive HD patients are deteriorated as compared to healthy controls.

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Section: Discussionmentioning

confidence: 99%

Echocardiographic assessment of right ventricular functions in nondiabetic normotensive hemodialysis patients

Karaveli̇oğlu

Özkurt

Kalçık

et al. 2015

IMAS

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“…187 On the contrary, the results from a German study showed similar left ventricular mass index with both modes of treatment. 188 It is therefore likely that the prevalence of left ventricular in pediatric dialysis patients is more dependent on the overall control of BP and on volume status than on dialysis modality.…”

Section: Hypertension In Pediatric Dialysis Patientsmentioning

confidence: 99%

Assessment and Management of Hypertension in Patients on Dialysis

Agarwal

Flynn

Pogue

et al. 2014

Journal of the American Society of Nephrology

161

156

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Hypertension is common, difficult to diagnose, and poorly controlled among patients with ESRD. However, controversy surrounds the diagnosis and treatment of hypertension. Here, we describe the diagnosis, epidemiology, and management of hypertension in dialysis patients, and examine the data sparking debate over appropriate methods for diagnosing and treating hypertension. Furthermore, we consider the issues uniquely related to hypertension in pediatric dialysis patients. Future clinical trials designed to clarify the controversial results discussed here should lead to the implementation of diagnostic and therapeutic techniques that improve long-term cardiovascular outcomes in patients with ESRD. Hypertension is common among patients with ESRD. In this review, we discuss the diagnosis, epidemiology, and management of hypertension among dialysis patients. We also review areas of existing controversies and briefly discuss the issue of hypertension in pediatric dialysis patients. EPIDEMIOLOGYThe prevalence, treatment, and control of hypertension among people on hemodialysis (HD) have used varying definitions to diagnose hypertension. The epidemiology differs based on how BP is measured: either before and after dialysis or using ambulatory BP recordings. Epidemiology with Routine BP MeasurementsThe prevalence of hypertension (defined as 1-week average predialysis systolic BP [SBP] measurements .150 mmHg or diastolic BP [DBP].85 mmHg or the use of antihypertensive medications) was 86% among 2535 clinically stable adult HD patients participating in a multicenter trial. 1 Among hypertensive patients, 12% did not receive antihypertensive drugs, 58% were treated but not controlled, and only 30% were controlled. The use of antihypertensive drugs has been reported to vary from 59% to 83%. [2][3][4][5] Furthermore, even among children on long-term HD, similar findings have been reported. 6 Several studies have confirmed greater antihypertensive drug use to be associated with poorer control. 7,8 It should be noted that antihypertensive drug use per se do not lead to worse BP control; in the absence of adequate volume control, increasing antihypertensive drug use may simply reflect difficult-to-control BP. Epidemiology Using Ambulatory BP MeasurementsThe prevalence of hypertension (defined by either a 44-hour interdialytic ambulatory BP of $135/85 mmHg or the prescription of any antihypertensive agent) was 86% among 369 chronic HD patients. 8 Although hypertension was being treated with antihypertensive drugs in 89% of patients, it was adequately controlled only in 38%. The independent determinants of poor control were the use of antihypertensive drugs and an expanded extracellular volume state. If patients were volume overloaded, nearly 80% became hypertensive when medications were Published online ahead of print. Publication date available at www.jasn.org.

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“…In pediatric patients who died in Europe on renal replacement therapy between 1987 and 1990, a cardiovascular cause of death was reported in 51% of dialyzed patients. [1] Although left ventricular systolic and diastolic dysfunction in adult patients has been reported, there has been limited data on cardiac functions in children with CRI and ESRD. [2] Few reports have examined whether hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) have different effects on the cardiac functions in children with ESRD.…”

Section: Introductionmentioning

confidence: 99%