Clinical and pathologic characteristics of dilated cardiomyopathy in hemodialysis patients

Aoki, Jiro; Ikari, Yuji; Nakajima, Hiroyuki; Mori, Masaya; Sugimoto, Tsuneaki; Hatori, Mitsuharu; Tanimoto, Shuzou; Amiya, Eisuke; Hara, Kazuhiro

doi:10.1111/j.1523-1755.2005.00086.x

Cited by 162 publications

(125 citation statements)

References 22 publications

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“…It is feasible that abnormal GLS is the precursor of overt uremic cardiomyopathy in dialysis patients. The mechanisms of abnormal GLS in ESRD are not fully clear, but may reflect interstitial fibrosis with myocyte hypertrophy (31). Furthermore, less negative GLS may be also associated with microvascular ischemia caused by the reduction in the density of myocardial capillaries, myocardial fibrosis, or hemodialysis-related myocardial stunning (32)(33)(34)(35).…”

Section: Discussionmentioning

confidence: 99%

Association of Left Ventricular Longitudinal Strain with Mortality among Stable Hemodialysis Patients with Preserved Left Ventricular Ejection Fraction

Liu¹,

Sung

et al. 2013

Clinical Journal of the American Society of Nephrology

101

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SummaryBackground and objectives Little is known about the optimal echocardiographic parameters for risk stratification in stable dialysis patients with preserved left ventricular ejection fraction (LVEF) (ejection fraction $50%). Left ventricular (LV) global peak systolic longitudinal strain (GLS) is the ratio of the maximal change in myocardial longitudinal length in systole to the original length and reliably and accurately assesses LV function. During systole, LV myocardium in the longitudinal direction shortens and GLS is represented by a negative value. The more negative value of GLS, the better the LV function is. This study hypothesized that subtle abnormalities of GLS are associated with an adverse prognosis.Design, setting, participants, & measurements This prospective study collected clinical and echocardiographic data (including GLS) from 88 stable hemodialysis patients (mean age 67.0611.2 years; 35% men) with preserved LVEF. These patients were enrolled from December 2008 to January 2009 and were followed-up for 25.669.9 months. The primary outcome was all-cause mortality. Multivariate Cox regression analysis was used to investigate risk factors for mortality.Results The mortality group (n=24) had lower albumin levels, less negative GLS, and higher prevalence of coronary artery disease and diabetes mellitus than the survival group. Using a GLS cutoff value of 215%, the less negative GLS group (GLS $215%) had a higher mortality rate. Cox regression analyses revealed that lower albumin level (hazard ratio, 0.16; 95% confidence interval, 0.05 to 0.53; P=0.003) and less negative GLS (hazard ratio, 3.57; 95% confidence interval, 1.41 to 9.04; P=0.01) were independent predictors of all-cause mortality. Furthermore, less negative GLS was associated with a higher cardiovascular death rate.Conclusions Less negative GLS is predictive of poor prognosis among stable hemodialysis patients with preserved LVEF.

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Section: Discussionmentioning

confidence: 99%

Association of Left Ventricular Longitudinal Strain with Mortality among Stable Hemodialysis Patients with Preserved Left Ventricular Ejection Fraction

Liu¹,

Sung

et al. 2013

Clinical Journal of the American Society of Nephrology

101

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“…Over time this stress of myocardial cells may result in partial apoptosis and subsequently in a progressive fibrosis that may develop in small areas of ischemia. Such extensive fibrosis is a further bad prognostic criteria in hemodialysis patients (49).…”

Section: Discussionmentioning

confidence: 99%

NT-proBNP and Troponin T Levels Differ after Haemodialysis with a Low versus High Flux Membrane

et al. 2015

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Background Brain natriuretic peptide (BNP), N-terminal-proBNP (NT-proBNP), and high sensitive cardiac troponin T (TnT) are markers that are elevated in chronic kidney disease and correlate with increased risk of mortality. Data are conflicting on the effect of biomarker levels by hemodialysis (HD). Our aim was to clarify to what extent HD with low-flux (LF) versus high-flux (HF) membranes affects the plasma levels of BNP, NT-proBNP, and TnT. Methods and Materials 31 HD patients were included in a crossover design, randomized to start dialysis with a LF-HD or HF-HD dialyzer. Each patient was his/her own control. The dialyses included in the study were the first treatments of two consecutive weeks with each mode of dialysis. Patients normally on hemodiafiltration (HDF) also performed a HDF the third week. Values after HD were corrected for extent of ultrafiltration. Results During LF-HD the biomarkers NT-proBNP and TnT increased (15 versus 6%, P≤.001) while there was a slight decrease in BNP (P<.05). During HF-HD the NT-proBNP, BNP and TnT levels decreased (P≤.01 for all). During HDF all three markers decreased (P<.01 for all). The rise in TnT during LF-HD correlated with dialysis vintage (months on HD, r = .407, P = .026), Kt/V-urea (r = .383, P = .037), HD time in hours/treatment (r = .447, P = .013) and inversely with residual urinary output (r = -.495, P = .005). The baseline levels of BNP and NT-proBNP correlated with blood pressure. Conclusions Cardiac biomarkers increase slightly during LF-HD. A HF-HD eliminates the biomarkers and can mask increases caused by, e.g., myocardial infarction.

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“…There are many potential reasons for the problem of sudden death: Abnormalities in the coronary microcirculation; impaired coronary reserve; reduced aortic compliance; increased activity of the sympathetic nervous system; the increased plasma concentration of angiotensin II; and sudden changes in the concentrations of potassium, calcium, and magnesium (which occur normally during dialysis) all can contribute to this problem. Another recent contributor to the problem of sudden death in this patient population may be related to the degree of fibrosis in the hearts of individuals on dialysis (22). In a recent study by Aoki et al (22), myocardial biopsies revealed abnormal cardiac myocyte anatomy and an interposition of dense fibrosis in the hearts of individuals who were on dialysis.…”

Section: Overview Of the Problem Of Cardiovascular Disease In Patientmentioning

confidence: 99%

Kidney-Heart Interactions

Berl

Henrich

2006

Clinical Journal of the American Society of Nephrology

189

121

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Clinical and pathologic characteristics of dilated cardiomyopathy in hemodialysis patients

Cited by 162 publications

References 22 publications

Association of Left Ventricular Longitudinal Strain with Mortality among Stable Hemodialysis Patients with Preserved Left Ventricular Ejection Fraction

Association of Left Ventricular Longitudinal Strain with Mortality among Stable Hemodialysis Patients with Preserved Left Ventricular Ejection Fraction

NT-proBNP and Troponin T Levels Differ after Haemodialysis with a Low versus High Flux Membrane

Kidney-Heart Interactions

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