The EFFECT OF PULMONARY HYPERTENSION ON INTRADIALYTIC HYPOTENSION AMONG PATIENTS WITH END STAGE RENAL DISEASE
Background: Intradialytic hypotension (IDH) is an important problem in end stage renal disease (ESRD). Therefore, this study aimed to assess the effect of pulmonary hypertension (PHT) on IDH among patients with ESRD using transthoracic echocardiography.
Methods: In this prospective etiognostic study, transthoracic echocardiography was performed among patients with ESRD in Burapha University Hospital, Thailand. The hemodialytic flow chart data of patients in the hemodialysis unit was collected to ascertain whether these patients presented IDH. The baseline clinical hemodialysis profiles and echocardiographic findings were analyzed using univariate predictors of IDH. Multivariate risk regression was used to identify independent predictors of IDH.
Results: A total of 35 patients with ESRD were enrolled between June 2020 and March 2021. Of these, 16 had PHT (45.7%). The incidence of IDH was 48.5%. All patients exhibited a normal left ventricular ejection fraction. No significant difference was observed of RVSP between frequent-IDH group and occasional-IDH group (45.33 ± 11.62 mmHg and 41.06 ± 13.78 mmHg, respectively, p=0.401). Using univariate analysis, being female, left ventricular mass index, left ventricular ejection fraction and PHT were significantly associated with IDH. No factors were indicated related to IDH occurrence using multivariate analysis. Nevertheless, female patients with ESRD presenting PHT illustrated a tendency to have IDH. This was evidenced by the risk ratio of being female and patients with PHT being 3.13 (95% CI: 0.74-13.30) and 2.18 (95% CI: 0.34-7.06), respectively.
Conclusion: Patients with ESRD presenting PHT showed a higher tendency of developing IDH during hemodialysis than patients with ESRD without PHT. The difference however was statistically insignificant.
Henrich WL. Hemodynamic instability during hemodialysis. Kidney Int 1986; 30: 605-12. DOI: https://doi.org/10.1038/ki.1986.228
Zucchelli P, Santoro A. Dialysis-induced hypotension: a fresh look at pathophysiology. Blood Purif 1993; 11: 85-98. DOI: https://doi.org/10.1159/000170102
Tisler A, Akocsi K, Harshegyi I, Varga G, Ferenczi S, Grosz M, et al. Comparison of dialysis and clinical characteristics of patients with frequent and occasional hemodialysisassociated hypotension. Kidney Blood Press Res 2002; 25: 97-102.
Shoji T, Tsubakihara Y, Fujii M, Imai E. Hemodialysis-associated hypotension as an independent risk factor for two-year mortality in hemodialysis patients. Kidney Inter 2004; 66: 1212-20. DOI: https://doi.org/10.1111/j.1523-1755.2004.00812.x
Flythe JE, Xue H, Lynch KE, Curhan GC, Brunelli SM. Association of mortality risk with various definitions of intradialytic hypotension. J Am Soc Nephrol 2015; 26: 724-34. DOI: https://doi.org/10.1681/ASN.2014020222
Burton JO, Jefferies HJ, Selby NM, McIntyre CW. Hemodialysis-induced cardiac injury: determinants and associated outcomes. Clin J Am Soc Nephrol 2009; 4: 914-20. DOI: https://doi.org/10.2215/CJN.03900808
Tarrass F, Benjelloun M, Medkouri G, Hachim K, Benghanem MG, Ramdani B. Doppler echocardiograph evaluation of pulmonary hypertension in patients undergoing hemodialysis. Hemodial Inter 2006; 10: 356-9. DOI: https://doi.org/10.1111/j.1542-4758.2006.00129.x
Yigla M, Abassi Z, Reisner S, Nakhoul F.Pulmonary hypertension in hemodialysis patients: an unrecognized threat. Semin Dial 2006; 9: 353–57. DOI: https://doi.org/10.1111/j.1525-139X.2006.00186.x
Li Z, Liu S, Liang X, Wang W, Fei H, Hu P, et al. Pulmonary hypertension as an independent predictor of cardiovascular mortality and events in hemodialysis patients. Inter Urol Nephrol 2014; 46: 141-9. DOI: https://doi.org/10.1007/s11255-013-0486-z
Fabbian F, Cantelli S, Molino C, Pala M, Longhini C, Portaluppi F. Pulmonary hypertension in dialysis patients: a cross-sectional Italian study. Int J Nephrol 2010; 2011: 283475. DOI: https://doi.org/10.4061/2011/283475
Ramasubbu K, Deswal A, Herdejurgen C, Aguilar D, Frost AE. A prospective echocardiographic evaluation of pulmonary hyper tension in chronic hemodialysis patients in the United States: prevalence and clinical significance. Int J Gen Med 2010; 3: 279–86. DOI: https://doi.org/10.2147/IJGM.S12946
Yigla M, Fruchter O, Aharonson D, Yanay N, Reisner SA, Lewin M, et al. Pulmonary hypertension is an independent predictor of mortality in hemodialysis patients. Kidney Inter 2009; 75: 969–75. DOI: https://doi.org/10.1038/ki.2009.10
Agarwal R. Prevalence, determinants and prognosis of pulmonary hypertension among hemodialysis patients. Nephrol Dial Transplant 2012; 27: 3908-14. DOI: https://doi.org/10.1093/ndt/gfr661
K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. Am J Kidney Dis 2005 ;45 DOI: https://doi.org/10.1053/j.ajkd.2005.01.019
Poldermans D, Man in ‘t Veld AJ, Rambaldi R, Van Den Meiracker AH, Van Den Dorpel MA, Rocchi G, et al. Cardiac evaluation in hypotension-prone and hypotension-resistant hemodialysis patients. Kidney Int 1999; 56: 1905-11. DOI: https://doi.org/10.1046/j.1523-1755.1999.00737.x
Kanbay M, Ertuglu LA, Afsar B, Ozdogan E, Siriopol D, Covic A, et al. An update review of intradialytic hypotension:concept, risk factors, clinical implications and management. Clin Kidney J 2020; 13: 981–93. DOI: https://doi.org/10.1093/ckj/sfaa078
Patrick B. Reeves, Finnian R. Mc Causland. Mechanisms, Clinical Implications, and Treatment of Intradialytic Hypotension. Clin J Am Soc Nephrol 2018; 13: 1297–303. DOI: https://doi.org/10.2215/CJN.12141017
Kawar B, Ellam T, Jackson C, Kiely DG. Pulmonary hypertension in renal disease: epidemiology, potential mechanisms and implications. Am J Nephrol 2013; 37: 281-90. DOI: https://doi.org/10.1159/000348804
Tisler A, Akocsi K, Harshegyi I, Varga G, Ferenczi S, Grosz M, et al. Comparison of dialysis and clinical characteristics of patients with frequent and occasional hemodialysis associated hypotension. Kidney Blood Press Res 2002; 25: 97-102. DOI: https://doi.org/10.1159/000063515
Kuipers J, Verboom LM, Ipema KJR, Paans W, Krijnen WP, Gaillard CAJM, et al. The prevalence of intradialytic hypotension in patients on conventional hemodialysis: A systematic review with meta-analysis. Am J Nephrol 2019; 49: 497-506. DOI: https://doi.org/10.1159/000500877
Kuipers J, Oosterhuis JK, Krijnen WP, Dasselaar JJ, Gaillard CAJM, Westerhuis R, et al. Prevalence of intradialytic hypotension, clinical symptoms and nursing interventionsa three-months, prospective study of 3818 haemodialysis sessions. BMC Nephrol 2016; 17: 1-11. DOI: https://doi.org/10.1186/s12882-016-0231-9
Orofino L, Marcén R, Quereda C, Villafruela JJ, Sabater J, Matesanz R, et al. Epidemiology of symptomatic hypotension in hemodialysis is cool dialysate beneficial for all patients? Am J Nephrol 1990; 10: 177–80. DOI: https://doi.org/10.1159/000168077
Chao CT, Huang JW, Yen CJ. Intradialytic hypotension and cardiac remodeling: a vicious cycle. Biomed Res Int 2015: 724147. DOI: https://doi.org/10.1155/2015/724147
Barberato SH, Misocami M, Pecoits-Filho R. Association between left atrium enlargement and intradialytic hypotension: role of diastolic dysfunction in the hemodynamic complications during hemodialysis. Echocardiography 2009; 26: 767-71. DOI: https://doi.org/10.1111/j.1540-8175.2008.00885.x
Gille J, Seyfarth HJ, Gerlach S, Malcharek M, Czeslick E, Sablotzki A. Perioperative anesthesiological management of patients with pulmonary hypertension. Anesthesiol Res Pract 2012; 2012: 356982. DOI: https://doi.org/10.1155/2012/356982
Minai OA, Yared JP, Kaw R, Subramaniam K, Hill NS. Perioperative risk and management in patients with pulmonary hypertension. Chest 2013; 144: 329-40. DOI: https://doi.org/10.1378/chest.12-1752
Copyright (c) 2022 Journal of Southeast Asian Medical Research
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright to all published articles will be held by Journal of Southeast Asian Medical Research. Copyright forms are handled by the production department of the publisher once a manuscript is accepted and scheduled for publication.