scholarly journals The cardiovascular determinants of physical function in patients with end-stage kidney disease on haemodialysis

2020 ◽  
Author(s):  
Sherna F. Adenwalla ◽  
Roseanne E. Billany ◽  
Daniel S. March ◽  
Gaurav S. Gulsin ◽  
Hannah M. L. Young ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Ejection Fraction ◽  
Physical Function ◽  
Left Ventricular ◽  
End Stage Kidney Disease ◽  
Exercise Interventions ◽  
Native T1 ◽  
Dialysis Vintage ◽  
Lv Ejection Fraction ◽  
End Stage

AbstractPatients with end-stage kidney disease (ESKD) are often sedentary and decreased functional capacity associates with mortality. The relationship between cardiovascular disease (CVD) and physical function has not been fully explored. Understanding the relationships between prognostically relevant measures of CVD and physical function may offer insight into how exercise interventions might target specific elements of CVD. 130 patients on haemodialysis (mean age 57 ± 15 years, 73% male, dialysis vintage 1.3 years (0.5, 3.4), recruited to the CYCLE-HD trial (ISRCTN11299707), underwent cardiovascular phenotyping with cardiac MRI (left ventricular (LV) structure and function, pulse wave velocity (PWV) and native T1 mapping) and cardiac biomarker assessment. Participants completed the incremental shuttle walk test (ISWT) and sit-to-stand 60 (STS60) as field-tests of physical function. Linear regression models identified CV determinants of physical function measures, adjusted for age, gender, BMI, diabetes, ethnicity and systolic blood pressure. Troponin I, PWV and global native T1 were univariate determinants of ISWT and STS60 performance. NT pro-BNP was a univariate determinant of ISWT performance. In multivariate models, NT pro-BNP and global native T1 were independent determinants of ISWT and STS60 performance. LV ejection fraction was an independent determinant of ISWT distance. However, age and diabetes had the strongest relationships with physical function. In conclusion, NT pro-BNP, global native T1 and LV ejection fraction were independent CV determinants of physical function. However, age and diabetes had the greatest independent influence. Targeting diabetic care may ameliorate deconditioning in these patients and a multimorbidity approach should be considered when developing exercise interventions.

Abstract 399: End-stage Heart Failure Causes Severe Lung Fibrosis and Dysfunction

2016 ◽  
Vol 119 (suppl_1) ◽  
Author(s):  
Xiaohong Liu ◽  
Huan Wang ◽  
Ruru Shang ◽  
Jin Zhang ◽  
Yingjie Chen
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Lung Fibrosis ◽  
Smooth Muscles ◽  
Lung Compliance ◽  
Left Ventricular ◽  
Lung Weight ◽  
Lung Dysfunction ◽  
Lv Ejection Fraction ◽  
End Stage

Chronic heart failure (CHF) causes trouble breathing in patients. We recently demonstrated that systolic pressure overload by transverse aortic constriction (TAC) causes severe left ventricular (LV) failure that is associated with massive lung fibrosis and lung vascular remodeling, and right ventricular (RV) dysfunction in mice. Here, we further studied the effect of CHF on lung structure and function in mice, and the effect of CHF on lung fibrosis in patients. We demonstrated that chronic TAC resulted in decrease of LV ejection fraction, and increases LV weight, lung weight, and RV weight, as well as their ratios to bodyweight. Interestingly, the development of LV failure is associated with a significant lung dysfunction as evidenced by a ~2-fold increase of lung resistance and a ~50% dramatic decrease of lung compliance in vivo . Lung compliance was also significantly reduced ~50% in lung isolated from CHF mice, indicating the decrease of lung compliance is due to the structure change of lung. The reduced lung compliance in CHF mice is significantly correlated with the decrease of LV ejection fraction, the increase of lung weight, and RV hypertrophy, suggesting the reduced lung compliance might contribute to the development of RV hypertrophy and failure. Histochemical analyses further demonstrated that CHF causes massive lung vascular, perivascular and interstitial fibrosis, as well as increase of lung myofibroblast proliferation. By using the chimeric mice created by transplantation of Bone Marrow Derived Cells (BMDCs) from GFP mice into wild type mice, we demonstrated that BMDCs contribute to the increased lung myofibroblasts and lung fibrosis. However, BMDCs don’t differentiate into lung smooth muscles cells in CHF mice. Moreover, we demonstrated that inhibition of lung inflammation by a cytokine therapy protocol is effective in attenuating TAC-induced lung fibrosis. Finally, we demonstrated that end-stage CHF causes increase of lung fibrosis in patients, and the increased lung fibrosis is associated with RV hypertrophy and dysfunction in patients. Together, our study demonstrated that end-stage CHF causes lung fibrosis and lung dysfunction, and inhibition of inflammation is effective in attenuating heart failure induced lung fibrosis.

scholarly journals Left-sided heart disease and risk of death in patients with end-stage kidney disease receiving haemodialysis: an observational study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Anna Axelsson Raja ◽  
Peder E. Warming ◽  
Ture L. Nielsen ◽  
Louis L. Plesner ◽  
Mads Ersbøll ◽  
...  
Keyword(s):  
Heart Disease ◽  
Kidney Disease ◽  
Left Ventricular ◽  
Valve Disease ◽  
Left Ventricular Ejection ◽  
Clinical Consequence ◽  
End Stage Kidney Disease ◽  
Risk Of Death ◽  
Echocardiographic Assessment ◽  
End Stage

Abstract Background Cardiovascular disease is the most common cause of death in patients with end-stage kidney disease on haemodialysis. The potential clinical consequence of systematic echocardiographic assessment is however not clear. In an unselected, contemporary population of patients on maintenance haemodialysis we aimed to assess: the prevalence of structural and functional heart disease, the potential therapeutic consequences of echocardiographic screening and whether left-sided heart disease is associated with prognosis. Methods Adult chronic haemodialysis patients in two large dialysis centres had transthoracic echocardiography performed prior to dialysis and were followed prospectively. Significant left-sided heart disease was defined as moderate or severe left-sided valve disease or left ventricular ejection fraction (LVEF) ≤40%. Results Among the 247 included patients (mean 66 years of age [95%CI 64–67], 68% male), 54 (22%) had significant left-sided heart disease. An LVEF ≤40% was observed in 31 patients (13%) and severe or moderate valve disease in 27 (11%) patients. The findings were not previously recognized in more than half of the patients (56%) prior to the study. Diagnosis had a potential impact on management in 31 (13%) patients including for 18 (7%) who would benefit from initiation of evidence-based heart failure therapy. After 2.8 years of follow-up, all-cause mortality among patients with and without left-sided heart disease was 52 and 32% respectively (hazard ratio [HR] 1.95 (95%CI 1.25–3.06). A multivariable adjusted Cox proportional hazard analysis showed that left-sided heart disease was an independent predictor of mortality with a HR of 1.60 (95%CI 1.01–2.55) along with age (HR per year 1.05 [95%CI 1.03–1.07]). Conclusion Left ventricular systolic dysfunction and moderate to severe valve disease are common and often unrecognized in patients with end-stage kidney failure on haemodialysis and are associated with a higher risk of death. For more than 10% of the included patients, systematic echocardiographic assessment had a potential clinical consequence.

scholarly journals Changes in measures of cognitive function in patients with end-stage kidney disease on dialysis and the effect of dialysis vintage: A longitudinal cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0252237
Author(s):  
Karumathil M. Murali ◽  
Judy Mullan ◽  
Steven Roodenrys ◽  
Hicham I. Cheikh Hassan ◽  
Maureen Lonergan
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Function ◽  
Kidney Disease ◽  
Analysis Of Covariance ◽  
End Stage Kidney Disease ◽  
Change Scores ◽  
Dialysis Vintage ◽  
One Year ◽  
End Stage

Introduction Prevalence of cognitive impairment increases with worsening severity of chronic kidney disease (CKD) and majority of end-stage kidney disease (ESKD) patients on dialysis have cognitive impairment. Trends of cognitive function (CF) in this population are less well known with published studies reporting conflicting results. Methods We assessed CF in a cohort of non-dialysis CKD and ESKD patients undergoing dialysis using modified mini-mental state examination (3MS), trail-making test (TMT-A & B) scores and Stroop task, and evaluated demographics, comorbidities and depression using Beck depression inventory at baseline. We repeated tests of CF and depression ≥ 1-year after baseline in both groups and compared change scores in CF and depression between ESKD/ CKD sub-groups. Among ESKD patients we compared change scores between patients with dialysis vintage of <1-year and >1-year. Analysis of covariance was used to adjust for the effect of age on these change scores. Results At baseline (N = 211), compared to CKD (N = 108), ESKD (N = 103) patients had significantly worse CF based on 3MS and TMT-A & B scores, and depression scores. On follow-up (N = 160) 3MS scores, especially the memory subscale significantly improved in ESKD, but worsened in CKD, with no significant changes in TMT A /TMT-B, or depression scores after adjusting for age. Among ESKD patients, 3MS, especially memory subscale improved in patients with dialysis vintage <1-year compared to >1-year. The 51 patients who discontinued after baseline assessment had worse baseline CF scores suggesting differential attrition. Conclusion Though baseline cognitive scores were worse in ESKD patients on dialysis, compared to CKD, their 3MS, especially memory subscale improved on follow-up. Among ESKD patients, the improvement was significant only in patients who have been on dialysis for less than one-year which may indicate a beneficial effect of clearance of uraemic toxins. Differential attrition of study subjects may have impacted the observed results.

scholarly journals Left ventricular geometric patterns in end-stage kidney disease: Determinants and course over time

2018 ◽  
Vol 22 (3) ◽  
pp. 359-368 ◽  
Author(s):  
Menso J. Nubé ◽  
Tiny Hoekstra ◽  
Volkan Doganer ◽  
Michiel L. Bots ◽  
Peter J. Blankestijn ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Left Ventricular ◽  
End Stage Kidney Disease ◽  
Geometric Patterns ◽  
End Stage ◽  
Over Time

Left ventricular stiffness in paediatric patients with end-stage kidney disease

2020 ◽  
Vol 35 (6) ◽  
pp. 1051-1060
Author(s):  
Ann Wing-man Choi ◽  
Nai-chung Fong ◽  
Vivian Wing-yi Li ◽  
Tsz-wai Ho ◽  
Eugene Yu-hin Chan ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Left Ventricular ◽  
End Stage Kidney Disease ◽  
Paediatric Patients ◽  
Left Ventricular Stiffness ◽  
End Stage

scholarly journals The differences in the physical function levels of end-stage kidney disease patients according to the therapeutic modalities employed

2017 ◽  
Vol 50 (4) ◽  
pp. 241-245
Author(s):  
Chiharu Hotta ◽  
Koji Hiraki ◽  
Akiko Wakamiya ◽  
Kazuhiro P. Izawa ◽  
Satoshi Watanabe ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Physical Function ◽  
End Stage Kidney Disease ◽  
Therapeutic Modalities ◽  
End Stage
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