Kronik Böbrek Yetmezliği Hastalarında Diyaliz Tipinin Sağ Kalp Fonksiyonları Üzerindeki Etkilerinin Karşılaştırılması

Abstract

Amaç: Bu çalışmanın amacı diyaliz tipinin sağ kalp fonksiyonlarına etkilerinin iki boyutlu speckle tracking ekokardiyografi (2D-STE) ile karşılaştırılmasıdır. Gereç ve Yöntemler: Kardiyoloji ve nefroloji polikliniklerine başvuran, periton diyalizi yapan ve hemodiyalize giren toplam 53 hasta çalışmaya dahil edildi. Sol kalp yetmezliği, koroner arter hastalığı, primer ve sekonder pulmoner hipertansiyon, pulmoner emboli, derin ven trombozu, orta ve ileri derecede kalp kapak yetmezliği ve darlığı olanlar çalışma dışı bırakıldı. Hastaların sosyodemografık özellikleri ve biyokimyasal parametreleri kaydedildi. 2D-STE ile hastaların sağ kalp fonksiyonları değerlendirildi. Bulgular: Yaş açısından gruplar arasında fark yoktu (p=0,496), hemodiyaliz grubunda erkek oranı daha yüksekti (p=0,006). 2D-STE ölçümleri karşılaştırıldığında; sağ atriyum (right atrium, RA) maksimum hacmi ve RA minimum hacmi hemodiyaliz hastalarında anlamlı olarak yüksekti (sırasıyla p=0,006; p=0,007). RA maksimum hacim indeksi, RA minimum hacim indeksi ve triküspit anulusunun sistolde apikale yer değiştirmesi (tricuspid annular plane systolic excursion, TAPSE) açısından gruplar arasında fark yoktu. Hemodiyaliz hastalarında RAS strain ve RAA strain anlamlı olarak daha düşüktü (sırasıyla p=0,001; p=0,012). Hemodiyaliz hastalarında TAPSE ile RA maksimum hacmi arasında (r=0,484; p=0,036) ve periton diyalizi hastalarında TAPSE ile RA minimum hacmi arasında (r=0,486; p=0,025) pozitif korelasyon bulundu. Sonuç: Sağ ventrikül fonksiyonları periton diyalizi ve hemodiyaliz hastalarında benzer bulundu. Sağ atriyal fonksiyonların periton diyalizi hastalarında hemodiyaliz hastalarına göre daha iyi korunduğu görüldü.

Keywords

• diyaliz
• sağ kalp fonksiyonları
• Speckle Tracking Ekokardiyografi

Comparison of the Effects of Dialysis Type on Right Heart Functions in Chronic Renal Failure Patients

Abstract

Aim: The aim of this study was to compare the effects of dialysis type on right heart functions with two-dimensional speckle tracking echocardiography (2D-STE). Material and Methods: A total of 53 patients who have peritoneal dialysis and hemodialysis, applied to cardiology and nephrology outpatient clinics, were included in the study. Those with left heart failure, coronary artery disease, primary and secondary pulmonary hypertension, pulmonary embolism, deep vein thrombosis, moderate and severe heart valve failure and stenosis were excluded from the study. Sociodemographic characteristics and biochemical parameters of the patients were recorded. Right heart functions of the patients were evaluated using 2D-STE. Results: There was no difference between groups with respect to age (p=0.496), the rate of male was higher in hemodialysis group (p=0.006). In comparison of 2D-STE measurements; right atrium (RA) maximum volume and RA minimum volume were significantly higher in hemodialysis patients (p=0.006, p=0.007, respectively). There were no difference between the groups in RA maximum volume index, RA minimum volume index and tricuspid annular plane systolic excursion (TAPSE). RAS strain and RAA strain were significantly lower in hemodialysis patients (p=0.001, p=0.012, respectively). A positive correlation was found between TAPSE and RA maximum volume in hemodialysis patients (r=0.484, p=0.036), and between TAPSE and RA minimum volume in peritoneal dialysis patients (r=0.486, p=0.025). Conclusion: Right ventricular functions were found to be similar in peritoneal dialysis and hemodialysis patients. It was observed that right atrial functions were better protected in peritoneal dialysis patients than hemodialysis patients.

Keywords

• Dialysis
• ; right heart functions
• Speckle Tracking Echocardiography

References

1. Erek E, Süleymanlar G, Serdengeçti K. Registry of the nephrology dialysis and transplantation in Turkey, (Registry 2004). İstanbul: Türk Nefroloji Derneği Yayınları; 2005.
2. Foley RN, Parfrey PS, Sarnak MJ. Epidemiology of cardiovascular disease in chronic renal disease. J Am Soc Nephrol. 1998;9:(12 Suppl):S16-23.
3. Sniderman AD, Solhpour A, Alam A, Williams K, Sloand JA. Cardiovascular death in dialysis patients: Lessons we can learn from AURORA. Clin J Am Soc Nephrol. 2010;5(2):335-40.
4. Goicoechea M, de Vinuesa SG, Gómez-Campderá F, Luño J. Predictive cardiovascular risk factors in patients with chronic kidney disease (CKD). Kidney Int Suppl. 2005;67(93):S35-8.
5. Wang AY, Lam CW, Chan IH, Wang M, Lui SF, Sanderson JE. Sudden cardiac death in end-stage renal disease patients: a 5-year prospective analysis. Hypertension. 2010;56(2):210-6.
6. Kalaycı A, Karabay CY, Taşar O, İzci S, Geçmen Ç, Vecih Oduncu V, et al. The effects of coronary artery disease severity on left atrial deformation parameters in patients with stable coronary artery disease. Turk Kardiyol Dern Ars. 2017;45(2):153-9.
7. Nesser HJ, Winter S. Speckle tracking in the evaluation of left ventricular dyssynchrony. Echocardiography. 2009;26(3):324-36.
8. Levey AS, Coresh J, GreeneT, Stevens LA, Zhang YL, Hendriksen S, et al. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med. 2006;145(4):247-54.

9. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010;23(7):685-713. quiz 786-8.
10. Semple D, Smith K, Bhandari S, Seymour AM. Uremic cardiomyopathy and insulin resistance: a critical role for akt? J Am Soc Nephrol. 2011;22(2):207-15.
11. Yao YH, Fu CH, Ho SJ, Tsai SH, Ng YY, Chuang CL, et al. Peritoneal dialysis as compared with hemodialysis is associated with higher over hydration but non-inferior blood pressure control and heart function. Blood Purif. 2012;34(1):40-7.
12. Enia G, Mallamaci F, Benedetto FA, Panuccio V, Parlongo S, Cutrupi S, et al. Long-term CAPD patients are volume expanded and display more severe left ventricular hypertrophy than hemodialysis patients. Nephrol Dial Transplant. 2001;16(7):1459-64.
13. Fagugli RM, Pasini P, Quintaliani G, Pasticci F, Ciao G, Cicconi B, et al. Association between extracellular water, left ventricular mass and hypertension in haemodialysis patients. Nephrol Dial Transplant. 2003;18(11):2332-8.
14. Konings CJ, Kooman JP, Schonck M, Dammers R, Cheriex E, Palmans Meulemans AP, et al. Fluid status, blood pressure, and cardiovascular abnormalities in patients on peritoneal dialysis. Perit Dial Int. 2002;22(4):477-87.
15. Günaydın ZY, Karagöz A, Bektaş O, Karataş MB, Karataş A, Bayramoğlu A, et al. The effects of dialysis-type on left ventricular function in non-diabetic end-stage renal disease patients. Acta Cardiol. 2016;71(6):709-16.
16. Tian JP, Wang T, Wang H, Cheng LT, Tian XK, Lindholm B, et al. The prevalence of left ventricular hypertrophy in Chinese hemodialysis patients is higher than that in peritoneal dialysis patients. Ren Fail. 2008;30(4):391-400.
17. Koga S, Ikeda S, Matsunaga K, Naito T, Miyahara Y, Taura K, et al. Influence of hemodialysis on echocardiographic Doppler indices of the left ventricle: changes in parameters of systolic and diastolic function and Tei index. Clin Nephrol. 2003;59(3):180-5.
18. Kawada H, Sumimoto T, Okayama H, Hiwada K. Structure and function of the left ventricle and carotid artery in hemodialysis patients. Hypertens Res. 2001;24(3):221-7.
19. Oki T, Tabata T, Yamada H, Wakatsuki T, Shinohara H, Nishikado A, et al. Clinical application of pulsed Doppler tissue imaging for assessing abnormal left ventricular relaxation. Am J Cardiol. 1997;79(7):921-8.
20. Agmon Y, Oh JK, McCarthy JT, Khandheria BK, Bailey KR, Seward JB. Effect of volume reduction on mitral annular diastolic velocities in hemodialysis patients. Am J Cardiol. 2000;85(5):665-8.
21. Pelà G, Regolisti G, Coghi P, Cabassi A, Basile A, Cavatorta A, et al. Effects of the reduction of preload on left and right ventricular myocardial velocities analyzed by Doppler tissue echocardiography in healthy subjects. Eur J Echocardiogr. 2004;5(4):262-71.
22. Vogel M, Schmidt MR, Kristiansen SB, Cheung M, White PA, Sorensen K, et al. Validation of myocardial acceleration during isovolumic contraction as a novel noninvasive index of right ventricular contractility: comparison with ventricular pressure-volume relations in an animal model. Circulation. 2002;105(14):1693-9.
23. Akkaya M, Erdoğan E, Sağ S, Arı H, Türker Y, Yılmaz M. The effect of hemodialysis on right ventricular functions in patients with end-stage renal failure. Anadolu Kardiyol Derg. 2012;12(1):5-10.
24. Eidem BW, O’Leary PW, Tei C, Seward JB. Usefulness of the myocardial performance index for assessing right ventricular function in congenital heart disease. Am J Cardiol. 2000;86(6):654-8.
25. Özdemir K, Balcı S, Düzenli MA, Can I, Yazıcı M, Aygül N, et al. Effect of preload and heart rate on the Doppler and tissue Doppler-derived myocardial performance index. Clin Cardiol. 2007;30(7):342-8.
26. Edwards NC, Hirth A, Ferro CJ, Townend JN, Steeds RP. Subclinical abnormalities of left ventricular myocardial deformation in early-stage chronic kidney disease: the precursor of uremic cardiomyopathy? J Am Soc Echocardiogr. 2008;21(12):1293-8.
27. Asrar ul Haq M, Rudd N, Subiakto I, Barlis P, Anavekar NS. Speckle tracking for assessment of left ventricular dyssynchrony. World J Cardiovasc Dis. 2014;4(4):149-55.
28. Ersan Demirci D, Demirci D, Çoban M, Yılmaz GM, Arslan Ş. Echocardiographic assessment of right ventricular function in peritoneal dialysis patients. Turk Kardiyol Dern Ars. 2019;47(2):88-94.
29. Paneni F, Gregori M, Ciavarella GM, Sciarretta S, De Biase L, Marino L, et al. Right ventricular dysfunction in patients with end-stage renal disease. Am J Nephrol. 2010;32(5):432-8.
30. Bektaş O, Günaydın ZY, Karagöz A, Kaya A, Kırış T, Yılmazer MS, et al. Effects of mitral balloon valvuloplasty on coronary blood flow and flow reserve. J Heart Valve Dis. 2015;24(6):729-35.
31. Edwards NC, Hirth A, Ferro CJ, Townend JN, Steeds RP. Subclinical abnormalities of left ventricular myocardial deformation in early-stage chronic kidney disease: the precursor of uremic cardiomyopathy? J Am Soc Echocardiogr. 2008;21(12):1293-8.
32. Maniar HS, Prasad SM, Gaynor SL, Chu CM, Steendijk P, Moon MR. Impact of pericardial restraint on right atrial mechanics during acute right ventricular pressure load. Am J Physiol Heart Circ Physiol. 2003;284(1):H350-7.
33. Gaynor SL, Maniar HS, Prasad SM, Steendijk P, Moon MR. Reservoir and conduit function of right atrium: impact on right ventricular filling and cardiac output. Am J Physiol Heart Circ Physiol. 2005;288(5):H2140-5.
34. Bening C, Leyh R. Right atrial contractile dynamics are impaired in patients with postcapillary pulmonary hypertension. Exp Ther Med. 2016;12(2):792-8.
35. Wright LM, Dwyer N, Wahi S, Marwick TH. Association with right atrial strain with right atrial pressure: an invasive validation study. Int J Cardiovasc Imaging. 2018;34(10):1541-8.