Cardiac imaging in patients with chronic kidney disease

Chiu, Diana; Green, Darren; Abidin, Nik; Sinha, Smeeta; Kalra, Philip A.

doi:10.1038/nrneph.2014.243

Cited by 34 publications

(36 citation statements)

References 104 publications

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“…In addition to superior image quality, MRI is the only imaging modality that can provide a complete and simultaneous assessment of cardiac morphology, cardiac output, global/regional contractile function, fibrosis, coronary artery flow and contrast-free measurement of myocardial perfusion [1]. Haemodynamic instability during dialysis plays a central role in the pathophysiology of cardiac disease.…”

Section: Introductionmentioning

confidence: 99%

Intradialytic Cardiac Magnetic Resonance Imaging to Assess Cardiovascular Responses in a Short-Term Trial of Hemodiafiltration and Hemodialysis

Buchanan

Mohammed

Cox

et al. 2016

JASN

129

118

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Hemodynamic stress during hemodialysis (HD) results in recurrent segmental ischemic injury (myocardial stunning) that drives cumulative cardiac damage. We performed a fully comprehensive study of the cardiovascular effect of dialysis sessions using intradialytic cardiac magnetic resonance imaging (MRI) to examine the comparative acute effects of standard HD versus hemodiafiltration (HDF) in stable patients. We randomly allocated 12 patients on HD (ages 32–72 years old) to either HD or HDF. Patients were stabilized on a modality for 2 weeks before undergoing serial cardiac MRI assessment during dialysis. Patients then crossed over to the other modality and were rescanned after 2 weeks. Cardiac MRI measurements included cardiac index, stroke volume index, global and regional contractile function (myocardial strain), coronary artery flow, and myocardial perfusion. Patients had mean±SEM ultrafiltration rates of 3.8±2.9 ml/kg per hour during HD and 4.4±2.5 ml/kg per hour during HDF (P=0.29), and both modalities provided a similar degree of cooling. All measures of systolic contractile function fell during HD and HDF, with partial recovery after dialysis. All patients experienced some degree of segmental left ventricular dysfunction, with severity proportional to ultrafiltration rate and BP reduction. Myocardial perfusion decreased significantly during HD and HDF. Treatment modality did not influence any of the cardiovascular responses to dialysis. In conclusion, in this randomized, crossover study, there was no significant difference in the cardiovascular response to HDF or HD with cooled dialysate as assessed with intradialytic MRI.

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Section: Introductionmentioning

confidence: 99%

Intradialytic Cardiac Magnetic Resonance Imaging to Assess Cardiovascular Responses in a Short-Term Trial of Hemodiafiltration and Hemodialysis

Buchanan

Mohammed

Cox

et al. 2016

JASN

129

118

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“…In this patient group, cardiac structure and function are frequently abnormal and 74% of patients with CKD stage 5 have LVH at the initiation of renal replacement therapy (RRT). Cardiac changes, such as LVH and impaired LV systolic function have been associated with an unfavorable prognosis [11]. To our knowledge this is the first longitudinal study that describes an important and association between the degree of RRF and LVH in PD patients before RRT and after first years of dialysis treatment.…”

Section: Discussionmentioning

confidence: 91%

The Effect of Preserved Residual Renal Function on Left Ventricular Structure in Non-Anuric Peritoneal Dialysis Patients

Rebić

Matovinović

Rašić

et al. 2015

Kidney Blood Press Res

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Background/Aims: Residual renal function (RRF) has been shown to influence survival of peritoneal dialysis (PD) patients. This study examined the relations between RRF and left ventricular hypertrophy (LVH) before switching on dialysis treatment and observed during 18 months on PD treatment. Methods: A prospective longitudinal study was performed in 50 non-anuric (defined as >200 mL urine output in a 24-hour period) PD patients. Echocardiography, RRF and other known risk factors for the increase of LV mass index (LVMi) were determined at study baseline and the end of follow-up. Results: There was 78% patients with LVH in end-stage renal disease (ESRD) baseline and 60% at the end of follow-up. RRF at the start of the study showed no significant difference between patients with normal and increased LVMi, as well as in daily collection of urine. After 18 months, patients with decreased LVMi had better RRF, lower CRP and better Kt/V compared to patients with increased LVMi (p < 0.001). Patients with better preserved RRF not only had significantly higher total Kt/V, but were less anemic and hypoproteinemic and lesser presence of LVH. Conclusions: PD in non-anuric ESRD patients the first 18 months has a positive effect on the preservation of RRF and partial regression of left ventricular remodeling.

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“…Despite the prevalence of underlying cardiac abnormalities, symptoms may not manifest in many patients. 13 Abnormalities in LV size and function are common in dialysis patients due to a variety of reasons, such as volume overload, anemia, secondary hyperparathyroidism, chronic inflammation, and malnutrition. 14 In a study by Wang et al, 15 they showed that in adult chronic PD patients, the prevalence of LVH was noted to be as high as 94.8%.…”

Section: Discussionmentioning

confidence: 99%

Valvular calcification and left ventricular modifying in peritoneal dialysis patients

Rebić¹,

Rašić²,

Hamzić-Mehmedbašić³

et al. 2015

Renal Failure

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Background: Cardiac valve calcification (CVC) and left ventricular (LV) alterations are frequent complication in end-stage renal disease (ESRD). We determined the prevalence of CVC and LV hypertrophy (LVH) in ESRD patients before renal replacement therapy and 12 months after peritoneal dialysis (PD). Methods: A prospective longitudinal of 50 incident PD patients was studied. Demographic and clinical data were recorded and blood assayed at baseline and after 1-year of follow-up. CVC and LVH were evaluated by M-mode two-dimensional echocardiography. Results: CVC of the mitral and aortic valves and of both valves were noted in 30, 18 and 10% of patients, respectively. After 12 months of PD regimen, 20% patients had aortic, 24% mitral and 8% had calcification of both valves. After one year of PD, LVH was 62 and 36% in patients with and without CVC, respectively (p50.05). Endothelin-1 is an independent predictor of CVC at the baseline, while nitric oxide is inversely an independent predictor at the end of follow-up. Conclusions: CVC is associated with LVH in PD patients. These findings identified a potential role for monitored markers to be incorporated into therapeutic strategies aimed at detection and treatment of cardiovascular complications and prevention strategies.

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Cardiac imaging in patients with chronic kidney disease

Cited by 34 publications

References 104 publications

Intradialytic Cardiac Magnetic Resonance Imaging to Assess Cardiovascular Responses in a Short-Term Trial of Hemodiafiltration and Hemodialysis

Intradialytic Cardiac Magnetic Resonance Imaging to Assess Cardiovascular Responses in a Short-Term Trial of Hemodiafiltration and Hemodialysis

The Effect of Preserved Residual Renal Function on Left Ventricular Structure in Non-Anuric Peritoneal Dialysis Patients

Valvular calcification and left ventricular modifying in peritoneal dialysis patients

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