Pulmonary hypertension and right ventricular dysfunction in hemodialysis patients

L.-J. Zhao, S.-M. Huang, T. Liang, H. Tang

Department of Nephrology, and 1Department of Cardiology; West China Hospital, Sichuan
University, Chengdu, Sichuan Province, China. hsongm@medmail.com.cn

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• Cardiology

OBJECTIVE: Hemodialysis treatment has been revealed to increased the systolic pulmonary artery pressure (sPAP). Right ventricular dysfunction (RVD) had been demonstrated to predict mortality in chronic renal failure patients. We investigate the prevalence of pulmonary hypertension and RVD among patients and possible contributing factors for pulmonary hypertension.

PATIENTS AND METHODS: A cross-sectional survey consisted of 70 hemodialysis patients was performed in our hemodialysis center. By using echocardiography, an estimated systolic pulmonary artery pressure of > 35 mmHg at rest met the criterion of pulmonary hypertension. Tissue Doppler imaging (TDI) of the right ventricle was performed in all patients.

RESULTS: 27 out of 70 (38.57%) patients met the definition of pulmonary hypertension, while 32 out of 70 (45.71%) patients met the definition of RVD. Compared to patients without pulmonary hypertension, patients with pulmonary hypertension demonstrated higher systolic blood pressure and lower left ventricular ejection fraction (LVEF). RVD, indicated by TDI myocardial performance index (MPI), was worse impaired in patients with pulmonary hypertension. Echocardiographic findings suggested elevated MPI values of right ventricular and right ventricular wall thickness were significantly associated with sPAP. While a high level of LVEF and Kt/V values was inversely correlated with sPAP. The multivariate determinants of pulmonary hypertension were systolic blood pressure and Kt/V values.

CONCLUSIONS: Among hemodialysis patients, pulmonary hypertension is extraordinary common and is significantly associated with RVD. The poor control of systolic blood pressure and volume overload have played an important role in the mechanism of pulmonary hypertension in chronic uremia patients.

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