Pulmonary hypertension in hemodialysis patients without arteriovenous fistula: the effect of dialyzer composition

Abstract

Pulmonary hypertension (PHT) increases mortality rate in hemodialysis (HD) patients. Numerous clinical, hemodynamic, and metabolic abnormalities have been suggested to be associated with the development of PHT in HD patients. We aimed to investigate the acute effects of two different dialyzer membranes on pulmonary arterial pressure (PAP) throughout a HD session in maintenance HD patients. Seventy-four HD patients dialyzed through permanent tunneled jugular central venous catheter were enrolled. A first-use cellulose acetate and high-flux polysulfone dialysis membrane were tested using a crossover design. For each membrane, pre-and post-dialysis pulmonary artery pressures were measured echocardiographically. Elevated pulmonary artery pressure was observed in 68.8% of patients (n = 51), whereas mild PHT was observed in 28.3% of patients (n = 21) and moderate PHT in 40.5% (n = 30). Decrease in pulmonary artery pressure following HD procedure performed using high-flux polysulfone membrane was significantly higher than the decrease observed following HD procedure performed using cellulose acetate membrane (p < 0.05). Significant decrease in pulmonary artery pressures was observed only after HD procedures performed using high-flux polysulfone membrane (p < 0.05). Ultrafiltered volume was only significantly correlated with the decrease in pulmonary artery pressure observed after HD procedure performed through high-flux polysulfone membrane (b = 0.411, p < 0.05). PHT seems to be prevalent among HD patients even in the absence of AV fistula and abnormal cardiac functions. Membrane composition seems to be important, which may overwhelm the improving effects of ultrafiltration.

Pulmonary Hypertension among Patients on Dialysis and Kidney Transplant Recipients

“…Our study showed a high prevalence of PAH among HD patients and less frequent in PD and transplant recipients. Previous studies, though reported various frequency of PAH, have indicated a significantly higher frequency of PAH in HD than in PD patients [2][3][4][5][6][7][8][9] and improvement of PAH in ESRD patients after kidney transplantation. 18 These results indicate that patients on PD and transplant recipients are at a significantly lower risk for PAH compared with patients on HD.…”

“…1 Pulmonary arterial hypertension (PAH) is another severe and progressive cardiac complication that has been recently under attention and frequently seen among ESRD patients. Studies showed a frequency of about 19% to 70% in patients on chronic hemodialysis (HD) [2][3][4][5][6][7][8][9] and 6% to 19% in patients on continuous peritoneal dialysis (PD). 2,5,8,10 Several studies showed that PAH is associated with increased mortality and poor outcomes in patients on dialysis and also after renal transplantation.…”

Pulmonary hypertension in patients with stage 1-3 chronic kidney disease

“…The prevalence of PH ranges from 9-39% in predialysis patients with stage-5 CKD (Yigla et al, 2003;Buemi et al, 2007;Havlucu et al, 2007;Abdelwhab and Elshinnawy, 2008;Issa et al, 2008), 18.8-68.8% in hemodialysis patients, and 0-42% in individuals on peritoneal dialysis therapy (Kumbar et al, 2007;Bozbas et al, 2009;Unal et al, 2009;Casas-Aparicio et al, 2010;Kiykim et al, 2010;Fabbian et al, 2011;Agarwal, 2012;Etemadi et al, 2012). In our study, 37 of 128 (28.91%) CKD patients from China, who accepted no dialysis or renal transplantation, had Doppler-derived PASP ≥ 35 mmHg.…”

“…Often, a fixed estimate of right atrial pressure is added when the inferior vena cava is not evaluated during echocardiography. Varied cutoffs of PH have been adopted in studies, ranging from 25 to ≥45 mmHg (Yigla et al, 2009;Kiykim et al, 2010), which result in different conclusions about PH prevalence. Here, we adopted the PH diagnostic criteria as a PASP ≥ 35 mmHg (Buemi et al, 2007).…”

“…PH in patients with CKD may be induced and/or aggravated by left ventricular (LV) disorders as well as the presence of risk factors typical to CKD, including volume overload, an arteriovenous fistula (Abdelwhab and Elshinnawy, 2008), sleep-disordered breathing (Sakaguchi et al, 2011), exposure to dialysis membranes (Kiykim et al, 2010), endothelial dysfunction (Zoccali, 2007), vascular calcification and stiffening, and severe anemia (Buemi et al, 2007). Preventing PH in this population is crucial, as even kidney transplantation may not reverse the high mortality associated with PH.…”