Pulmonary Hypertension in Dialysis Patients

Kosmadakis, George; Aguilera, Didier; Carceles, Odette; Correia, Enrique Da Costa; Boletis, Ioannis

doi:10.3109/0886022x.2013.766559

Cited by 34 publications

(30 citation statements)

References 49 publications

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“…This process can result in pulmonary arterial hypertension and right heart failure. Similar reports of development of pulmonary hypertension in patients with an extracardiac arteriovenous connection are seen in patients with AV fistulae for dialysis in end-stage renal disease and hereditary haemorrhagic telangiectasia 7 8…”

Section: Discussionsupporting

confidence: 70%

Thinking outside the box: a middle-aged man with new-onset dyspnoea on exertion and pedal oedema

et al. 2015

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SUMMARYWe describe a diagnostic dilemma in a middle-aged man presenting with dyspnoea and bilateral pedal oedema who had been diagnosed with right heart failure based on clinical evidence. The evaluation for aetiology eventually led to discovery of an unusual extrathoracic cause, a left-to-right communication in the renal vasculature. Renal arteriovenous fistulae are rare and can be congenital, acquired or idiopathic. A left-to-right shunt typically presents with high-output cardiac failure involving the left and right sides of the heart. An atypical feature of this case was the finding of overt right heart failure in the setting of a normal left heart. Such a presentation has only been described in a few isolated case reports. Diagnostic approaches include CT angiography and cardiac catheterisation for haemodynamic measurements. The primary treatment options for arteriovenous fistulae are medical management, arterial embolisation and surgical repair. BACKGROUND

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Section: Discussionsupporting

confidence: 70%

Thinking outside the box: a middle-aged man with new-onset dyspnoea on exertion and pedal oedema

et al. 2015

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“…Pulmonary hypertension has resolved after renal transplantation and banding or closure of AVFs. 6 An association between AVF flow and elevated pulmonary artery pressures was reported after an observational study of 34 patients. Those investigators 7 found lower flow rates in radial AVFs than in brachial AVFs, which suggests that distally placed AVFs decrease the risk of RHF and PH.…”

Section: Discussionmentioning

confidence: 94%

Right Ventricular Enlargement within Months of Arteriovenous Fistula Creation in 2 Hemodialysis Patients

Ragupathi¹,

Johnson²,

Marhefka³

2016

Texas Heart Institute Journal

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Surgically created arteriovenous fistulae (AVF) for hemodialysis can contribute to hemodynamic changes. We describe the cases of 2 male patients in whom new right ventricular enlargement developed after an AVF was created for hemodialysis. Patient 1 sustained high-output heart failure solely attributable to the AVF. After AVF banding and subsequent ligation, his heart failure and right ventricular enlargement resolved. In Patient 2, the AVF contributed to new-onset right ventricular enlargement, heart failure, and ascites. His severe pulmonary hypertension was caused by diastolic heart failure, diabetes mellitus, and obstructive sleep apnea. His right ventricular enlargement and heart failure symptoms did not improve after AVF ligation. We think that our report is the first to specifically correlate the echocardiographic finding of right ventricular enlargement with AVF sequelae. Clinicians who treat end-stage renal disease patients should be aware of this potential sequela of AVF creation, particularly in the upper arm. We recommend obtaining preoperative echocardiograms in all patients who will undergo upper-arm AVF creation, so that comparisons can be made postoperatively. Alternative consideration should be given to creating the AVF in the radial artery, because of less shunting and therefore less potential for right-sided heart failure and pulmonary hypertension. A multidisciplinary approach is optimal when selecting patients for AVF banding or ligation.

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“…The actual effects on LVH in patients with underlying resistant hypertension have yet to be studied. The development of pulmonary hypertension as a result of AV fistula formation has been described in literature [20]. While current studies with the ROX Coupler demonstrated an increase in pulmonary arterial pressure and pulmonary capillary wedge pressure, there were no changes in pulmonary vascular resistance.…”

Section: Potential Side Effects Of Therapymentioning

confidence: 94%

The Thrill of Success: Central Arterial-Venous Anastomosis for Hypertension

et al. 2014

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Excess blood pressure remains the most important risk factor for cardiovascular and renal disease. Poly pharmacy has been proved safe and effective under clinical trial circumstances; however, the majority of patients fail to sustain pharmaceutical persistence and adherence. The opportunity to offer patients a treatment or device in addition or perhaps instead of drug therapy alone may significantly broaden the options for patients and allow greater success in hypertensive therapy. In this review, we examine the potential of a fixed-volume central arterial-venous anastomosis to reduce blood pressure in hypertensive patients, review possible mechanisms by which the anastomosis may reduce blood pressure, and consider the unique clinical trial opportunities posed by this therapy.

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Pulmonary Hypertension in Dialysis Patients

Cited by 34 publications

References 49 publications

Thinking outside the box: a middle-aged man with new-onset dyspnoea on exertion and pedal oedema

Thinking outside the box: a middle-aged man with new-onset dyspnoea on exertion and pedal oedema

Right Ventricular Enlargement within Months of Arteriovenous Fistula Creation in 2 Hemodialysis Patients

The Thrill of Success: Central Arterial-Venous Anastomosis for Hypertension

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