scholarly journals LEFT VENTRICULAR DIASTOLIC DYSFUNCTION ON NON HEMODIALYSIS DAYS IN END STAGE RENAL DISEASE PATIENTS IS ASSOCIATED WITH POOR OUTCOMES

2021 ◽  
Vol 77 (18) ◽  
pp. 1359
Author(s):  
Muhammad Saad ◽  
Shoaib Ashraf ◽  
Upreti Prakash ◽  
Nikee Shrestha ◽  
Sarthak Kulshrestha ◽  
...  
Keyword(s):  
Renal Disease ◽  
Diastolic Dysfunction ◽  
End Stage Renal Disease ◽  
Left Ventricular Diastolic Dysfunction ◽  
Left Ventricular ◽  
Ventricular Diastolic Dysfunction ◽  
Poor Outcomes ◽  
Stage Renal Disease ◽  
End Stage

scholarly journals Clinical Manifestations of Cardiac Disease in Patients with End Stage Renal Disease Under Maintenance Hemodialysis in a Tertiary Level Hospital of Nepal

2016 ◽  
Vol 15 (1) ◽  
pp. 61-65
Author(s):  
Kumar Roka ◽  
Pratibha Bista Roka
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Low Voltage ◽  
Clinical Manifestations ◽  
Left Ventricular Diastolic Dysfunction ◽  
Left Ventricular ◽  
Maintenance Hemodialysis ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Introduction: End stage renal disease presents with multiple clinical and systemic manifestations. The aim of the present study was to identify the early cardiac and other morbidities in end stage renal disease (ESRD) patients who were under maintenance hemodialysis.Methods: This was an observational, prospective study conducted in fifty established ESRD patients of 20 to 74 years under maintenance hemodialysis in Nephrology unit of Shree Birendra Hospital. Clinical examination, laboratory parameters, electrocardiogram and echocardiography findings were used to identify the morbidities. Results: Among all patients enrolled in the study 88.7% had anemia, 64.2 % systolic murmurs, 62.26 % pedal edema, 73.6 % fatiguability, 71.7 % angina, 24.4 % palpitations and 13.2 % had breathlessness on exertion.  62.26% of the patients had hypertension and 13.20 % had diabetes. In the electrocardiogram, prolonged QTc was observed in 10.4%, followed by T wave inversion in 9.4 % and finally low voltage complex comprised 7.6 %. The echocardiogram showed left ventricular diastolic dysfunction in 58.5 %, left ventricular hypertrophy (overall type) 49 % and valvular lesion like mitral regurgitation and tricuspid regurgitation 83 % and 58.5 % respectively. Conclusion: Cardiac co-morbidities are common in patients diagnosed with ESRD on maintenance hemodialysis.

Prevalence of Left Ventricular Diastolic Dysfunction by Tissue Doppler Imaging in Patients with End Stage Renal Disease undergoing Regular Dialysis with Preserved Systolic Function

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ahmed A Elkaialy ◽  
Walid M Sallam ◽  
Sameh S Thabet ◽  
Magdy A Gharieb
Keyword(s):  
Renal Disease ◽  
Diastolic Dysfunction ◽  
Tissue Doppler Imaging ◽  
End Stage Renal Disease ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Abstract Background Left ventricular hypertrophy (LVH) is the principal myocardial alteration in patients with ESRD due to multiple preload and afterload factors related to hemodialysis leading to left ventricular diastolic dysfunction manifested by signs and symptoms of heart failure with preserved ejection fraction (HFpEF). The use of echocardiography and tissue Doppler imaging is essential to detect diastolic dysfunction in ESRD patients undergoing hemodialysis as the prevalence of diagnosing HFpEF in ESRD patients is under-estimated. Objective To evaluate the possible impact of renal replacement therapy in the form of regular dialysis provided to end stage renal disease patients on left ventricular diastolic function by implementing tissue doppler imaging. Patients and Methods The study included 100 ESRD patients on regular dialysis presenting to the dialysis unit in Ain Shams University Hospitals. The inclusion criterion was end stage renal disease patients with GFR < 15 ml/min/1.73 m2 on regular dialysis for more than 6 months. Excluded patients were those above than 80 yrs old, with hemodynamic instability, arrhythmias, valvular diseases, ischemic conditions, and LV systolic dysfunction. After the hemodialysis session, ECG gated echocardiography was done applying pulsed wave Doppler on mitral valve to detect E/A ratio, continuous wave Doppler on tricuspid valve to calculate TR vmax, and tissue Doppler on lateral mitral annulus to detect e’ and E/e’ ratio. Moreover, left atrial volume index (LAVI) and other standard echocardiographic parameters were measured. Full history and clinical examination including ECG recording was done and blood samples were taken to measure hemoglobin levels. Patients were then stratified according to their diastolic dysfunction grading. Results Seventy eight percent (78%) of the patients showed diastolic dysfunction including 46 % showed grade I diastolic dysfunction, 26 % showed grade II diastolic dysfunction and 6% showed grade III diastolic dysfunction. Hemoglobin levels showed significant negative correlation with E, E/A, E/E’, LAVI and TR Vmax (r = -0.25, -0.37, -0.29, -0.23 and -0.31 with p 0.012, <0 .001, < 0.003, 0.002 & <0 .001 respectively). Multiple regression analysis revealed smoking, DM, Hb, LVPWd, EF, E/A, LAVI and TR Vmax presented the important determinants of diastolic filling (β = -0.16, 0.15, -0.20, -0.27, -0.25, 0.16, 0.39 & 0.27 and p = 0.002, 0.045, < 0.001, 0.022, < 0.001, 0.039, < 0.001 & < 0.001 respectively). Comparing E/A ratio with E/e’ ratio sensitivities revealed E/A ratio was 28.2% while E/e’ ratio was 74.3%. This was statistically significant showing a difference between the two modalities (χ2 = 33.2526 and p = < 0 .0001). Conclusion In ESRD patients, maladaptive events leading to LVH and diastolic dysfunction occur frequently. Thus, early identification and treatment of factors involved in order to prevent this devastating process. Now it seems that TDI and E, E/A and E/E’ parameters are good instruments for the early detection of LVH and diastolic dysfunction as they are important risk factors for cardiovascular morbidity and mortality in CKD. In comparison with the conventional Doppler techniques, tissue Doppler is a vital tool in diagnosing diastolic dysfunction.

scholarly journals Coronary microvascular dysfunction is associated with degree of anaemia in end‐stage renal disease

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ashwin Radhakrishnan ◽  
Luke C. Pickup ◽  
Anna M. Price ◽  
Jonathan P. Law ◽  
Kirsty C. McGee ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Renal Disease ◽  
Kidney Transplant ◽  
End Stage Renal Disease ◽  
Microvascular Dysfunction ◽  
Left Ventricular ◽  
Coronary Microvascular Dysfunction ◽  
Transplant Candidates ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background Coronary microvascular dysfunction (CMD) is common in end-stage renal disease (ESRD) and is an adverse prognostic marker. Coronary flow velocity reserve (CFVR) is a measure of coronary microvascular function and can be assessed using Doppler echocardiography. Reduced CFVR in ESRD has been attributed to factors such as diabetes, hypertension and left ventricular hypertrophy. The contributory role of other mediators important in the development of cardiovascular disease in ESRD has not been studied. The aim of this study was to examine the prevalence of CMD in a cohort of kidney transplant candidates and to look for associations of CMD with markers of anaemia, bone mineral metabolism and chronic inflammation. Methods Twenty-two kidney transplant candidates with ESRD were studied with myocardial contrast echocardiography, Doppler CFVR assessment and serum multiplex immunoassay analysis. Individuals with diabetes, uncontrolled hypertension or ischaemic heart disease were excluded. Results 7/22 subjects had CMD (defined as CFVR < 2). Demographic, laboratory and echocardiographic parameters and serum biomarkers were similar between subjects with and without CMD. Subjects with CMD had significantly lower haemoglobin than subjects without CMD (102 g/L ± 12 vs. 117 g/L ± 11, p = 0.008). There was a positive correlation between haemoglobin and CFVR (r = 0.7, p = 0.001). Similar results were seen for haematocrit. In regression analyses, haemoglobin was an independent predictor of CFVR (β = 0.041 95% confidence interval 0.012–0.071, p = 0.009) and of CFVR < 2 (odds ratio 0.85 95% confidence interval 0.74–0.98, p = 0.022). Conclusions Among kidney transplant candidates with ESRD, there is a high prevalence of CMD, despite the absence of traditional risk factors. Anaemia may be a potential driver of microvascular dysfunction in this population and requires further investigation.

Abstract 17623: A Case of Biopsy-proven Immunoglobulin G4-Related Disease Associated With Multiple Giant Coronary Artery Aneurysms, Peripheral Arterial Aneurysms, End Stage Renal Disease, and Heart Failure

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Mark D Benson ◽  
Cathryn Byrne-Dugan ◽  
Dale Adler ◽  
Mark Feinberg ◽  
Deepak Bhatt
Keyword(s):  
Heart Failure ◽  
Coronary Artery ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Coronary Arterial Disease ◽  
Related Disease ◽  
Stage Renal Disease ◽  
End Stage

A 54-year-old man with remote large cell non-Hodgkin’s lymphoma in remission following R-CHOP and severe atopic dermatitis was transferred from another hospital with a non-ST elevation myocardial infarction. Over the preceding year, the patient had suffered recurrent admissions for acutely decompensated heart failure with a newly depressed left ventricular ejection fraction (LVEF) of 20% by echocardiography and rapidly progressive end-stage renal disease of unclear etiology requiring the initiation of hemodialysis. Prior workup had demonstrated an infrarenal abdominal aortic aneurysm and bilateral common iliac artery aneurysms with subsequent computed tomography (CT) additionally demonstrating a superior mesenteric artery aneurysm. The patient was taken for immediate coronary arteriography, which demonstrated giant aneurysms in the left main and right coronary arteries, as well as multivessel severe stenoses. CT coronary angiogram demonstrated significant circumferential wall thickening throughout the coronary vasculature. Given concern for IgG4-related disease (IgG4-RD), a renal biopsy was pursued that confirmed the diagnosis. 18F-fluorodeoxyglucose positron emission tomography-CT identified only mild aortic inflammation. The patient was treated with high-dose steroids and rituximab. The serological inflammatory markers improved, and he underwent coronary artery bypass grafting. Pericardial, aortic adventitial, left internal mammary artery, and saphenous vein biopsies showed cardiovascular involvement of IgG4-RD. The patient has been maintained on rituximab with normalization of his LVEF and no recurrence of chest pain over the past eighteen months. IgG4-RD is a fibroinflammatory systemic disease newly described in 2003 and only recently found to involve the cardiovascular system with several reports of peripheral aneurysmal disease. To our knowledge, the current case represents the first report of a patient successfully treated for biopsy-proven IgG4-RD associated with coronary artery disease and left ventricular systolic dysfunction. IgG4-RD may represent a novel mechanism underlying some forms of peripheral and coronary arterial disease and may offer new insights into vascular biology.

Effect of Ultrafiltration on Sleep Apnea and Cardiac Function in End-Stage Renal Disease

2020 ◽  
Vol 51 (2) ◽  
pp. 139-146 ◽  
Author(s):  
Toru Inami ◽  
Owen D. Lyons ◽  
Elisa Perger ◽  
Azadeh Yadollahi ◽  
John S. Floras ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Renal Disease ◽  
Cardiac Function ◽  
End Stage Renal Disease ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Systolic And Diastolic Function ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Rationale: End-stage renal disease (ESRD) patients have high annual mortality mainly due to cardiovascular causes. The acute effects of obstructive and central sleep apnea on cardiac function in ESRD patients have not been determined. We therefore tested, in patients with ESRD, the hypotheses that (1) sleep apnea induces deterioration in cardiac function overnight and (2) attenuation of sleep apnea severity by ultrafiltration (UF) attenuates this deterioration. Methods: At baseline, ESRD patients, on conventional hemodialysis, with left ventricular ejection fraction (LVEF) >45% had polysomnography (PSG) performed on a non-dialysis day to determine the apnea-hypopnea index (AHI). Echocardiography was performed at the bedside, before and after sleep. Isovolumetric contraction time divided by left ventricular ejection time (IVCT/ET) and isovolumetric relaxation time divided by ET (IVRT/ET) were measured by tissue doppler imaging. The myocardial performance index (MPI), a composite of systolic and diastolic function was also calculated. One week later, subjects with sleep apnea (AHI ≥15) had fluid removed by UF, followed by repeat PSG and echocardiography. ­Results: Fifteen subjects had baseline measurements, of which 7 had an AHI <15 (no–sleep-apnea group) and 8 had an AHI ≥15 (sleep-apnea group). At baseline, there was no overnight change in the LVEF in either the no-sleep-apnea group or the sleep-apnea group. In the no-sleep-apnea group, there was also no overnight change in MPI, IVCT/ET and IVRT/ET. However, in the sleep-apnea group there were overnight increases in MPI, IVCT/ET and IVRT/ET (p = 0.008, 0.007 and 0.031, respectively), indicating deterioration in systolic and diastolic function. Following fluid removal by UF in the sleep-apnea group, the AHI decreased by 48.7% (p = 0.012) and overnight increases in MPI, IVCT/ET and IVRT/ET observed at baseline were abolished. Conclusions: In ESRD, cardiac function deteriorates overnight in those with sleep apnea, but not in those without sleep apnea. This overnight deterioration in the sleep-apnea group may be at least partially due to sleep apnea, since attenuation of sleep apnea by UF was accompanied by elimination of this deleterious overnight effect.

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