Son dönem böbrek hastalarinda hemodiyalizin sol ve sağ kalp fonksiyonlari üzerine etkisi English

Öz

Amaç: Kronik böbrek yetmezliği olan hastalarda morbidite ve mortalite riskinin arttığı bilinmektedir. Kronik böbrek yetmezliği olan hastalarda hemodiyalizin sol ve sağ ventrikül sistolik ve diyastolik fonksiyonları üzerine etkisini konvansiyonel ve doku Doppler ekokardiyografi ile değerlendirmeyi amaçladık.Materyal ve metod: Bu ileriye dönük gözlemsel çalışmada hemodiyaliz öncesi ve diyalizden 60 dakika sonra 41 üremik hasta ekokardiyografi ile değerlendirildi. İki boyutlu, M- Mode, konvansiyonel ve doku Doppler ekokardiyografi ile sol ve sağ ventrikülün sistolik ve diyastolik fonksiyonları ölçüldü.Bulgular: Hemodiyaliz sonrası kalp hızı anlamlı olarak artarken ortalama vücut ağırlığı, sistolik ve diyastolik kan basınçları azaldı hepsi için p

Anahtar Kelimeler

• Böbrek yetmezliği,hemodializ,atımlı Doppler ekokardiyografi

Effects of hemodialysis on the left and right heart functions in patients with end-stage renal disease

Öz

Background: It is known that patients with chronic renal failure are at increased risk for morbidity and mortality. We aimed to assess the effects of hemodialysis on certain parameters used to evaluate left and right ventricular systolic and diastolic functions using conventional and tissue Doppler echocardiography in patients with end-stage renal insufficiency.Methods: In this prospective observational study, 41 uremic patients were evaluated via echocardiography before and 60 minutes after hemodialysis. Systolic and diastolic functions of left ventricle LV and right ventricle RV were measured by two dimensional, M-Mode, conventional and tissue Doppler echocardiography. Results: While a significant increase was observed in the mean heart rate after hemodialysis, the mean body weight, systolic and diastolic blood pressure values were significantly decreased all p values< 0.01 . Compared to before hemodialysis, mitral E/ mitral annulus septal E' and mitral E/ mitral annulus lateral E' did not change p= 0.105 and p= 0.165 , but significant alterations were determined in many of M-Mode, conventional and other tissue Doppler echocardiographic parameters after hemodialysis all p values< 0.05 and < 0.01 . Conclusions: Mitral E/ septal E' and mitral E/ lateral E' did not change following hemodialysis and therefore are the best parameters to use to assess diastolic function in hemodialysis patients. Since the other conventional and traditional Doppler parameters vary with hemodialysis, these are not accurate measurements in these patients

Anahtar Kelimeler

• Renal insufficiency,hemodialysis,pulsed Doppler echocardiography

Kaynakça

1. ) National Kidney Foundation. K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: evaluation, classification and stratification. Am J Kidney Dis. 2002; 39(2 suppl 1): S1–S266.
2. ) Perez SG, Bernasconi A, Ballarin J, et al: Cardiovascular disease in patients with chronic renal failure: the cardio-renal axis. Rev Argent Cardiol. 2008: (3): 215–8.
3. ) Burton JO, Jefferies HJ, Selby NM, et al: Hemodialysis-induced cardiac injury: determinants and associated outcomes. Clin J Am Soc Nephrol 2009; 4(5): 20.
4. ) Mclntyre CW, Burton JO, Selby NM, et al: Hemodialysis-induced cardiac dysfunction is associated with an acute reduction in global and segmental myocardial blood flow. Clin J Am Soc Nephrol 2008; (1): 19-26.
5. ) Green D, Roberts PR, New DI, et al: Sudden cardiac death in hemodialysis patients: an in-depth review. Am J Kidney Dis 2011; 57(6): 921-29.
6. ) Pecoits-Filho R, Bucharles S, Barberato SH: Diastolic heart failure in dialysis patients: mechanisms, diagnostic approach, and treatment. Semin Dial 2012; 25(1): 35-41.
7. ) Sharma R: Screening for cardiovascular disease in patients with advanced chronic kidney disease. J Ren Care 2010; 36 (Suppl 1): 68-75.
8. ) Pecoits-Filho R, Barberato SH: Echocardiography in chronic kidney disease: diagnostic and prognostic implications. Nephron Clin Pract. 2010; 114(4): c242

9. ) Hung KC, Huang HL, Chu CM, et al: Evaluating preload dependence of a novel Doppler application in assessment of left ventricular diastolic function during hemodialysis. Am J Kidney Dis. 2004; 43(6): 1040-46.
10. ) Sahn DJ, DeMaria A, Kisslo J, et al: Recommendations regarding quantitation in M-mode e c h o c a r d i o g r a p h y : r e s u l t s o f a s u r v e y o f echocardiographic measurements. Circulation 1978; (6):1072-83.
11. ) Self S, Allen J, Oxborough D: Echocardiographic methods for quantification of left ventricular ejection fraction: are they interchangeable? Ultrasound 2010; 18: –81
12. ) Rudski LG, Lai WW, Afilalo J, 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. ; 23(7):685-713
13. ) Nagueh SF, Appleton CP, Gillebert TC, et al: Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Eur J Echocardiogr. 2009; 10(2):165-93
14. ) Ganda A, Weiner SD, Chudasama NL, et al: Echocardiographic changes following hemodialysis initiation in patients with advanced chronic kidney disease and symptomatic heart failure with reduced ejection fraction. Clin Nephrol. 2012; 77(5):366-75.
15. ) Bjällmark A, Larsson M, Nowak J, L et al: Effects of hemodialysis on the cardiovascular system: quantitative analysis using wave intensity wall analysis and tissue velocity imaging. Heart Vessels 2011; 26(3):289-97
16. ) Hung KC, Huang HL, Chu CM, et al: Effects of altered volume loading on left ventricular hemodynamics and diastolic filling during hemodialysis. ; 26(2):141-47. ) Lopez-Candales A, Rajagopalan N, Saxena N, et al: Right ventricular systolic function is not the sole determinant of tricuspid annular motion. Am J Cardiol ; 98(7):973-77
17. ) Akkaya M, Erdogan E, Sag S, et al: The effect of hemodialysis on right ventricular functions in patients with end-stage renal failure. Anadolu Kardiyol Derg ; 12(1):5-10
18. ) Barberato SH, Mantilla DE, Misocami MA, et al: Effect of preload reduction by hemodialysis on left atrial volume and echocardiographic Doppler parameters in patients with end-stage renal disease. Am J Cardiol 2004; (9):1208-10.
19. ) Graham RJ, Gelman JS, Donelan L, et al: Effect of preload reduction by haemodialysis on new indices of diastolic function. Clin Sci 2003; 105(4):499-506.
20. ) Tei C, Nishimura RA, Seward JB, et al: Noninvasive Doppler-derived myocardial performance index: correlation with simultaneous measurements of cardiac catheterization measurements. J Am Soc Echocardiog ; 10(2):169-78. ) Vizzardi E, D'Aloia A, Bordonali et al: Long-term prognostic value of the right ventricular myocardial performance index compared to other indexes of right ventricular function in patients with moderate chronic heart failure. Echocardiography 2012; 29(7):773-8.
21. ) Ulucam M, Yildirir A, Muderrisoglu H, et al: Effects of hemodialysis on myocardial performance index. Adv Ther ; 21(2):96-106. ) Koga S, Ikeda S, Matsunaga 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; (3):180-85.
22. ) Lee TY, Kang PL, Hsiao SH, et al: Tissue Doppler velocity is not totally preload-independent: a study in a uremic population after hemodialysis.Cardiology 2007; (4):415-21
23. ) Oğuzhan A, Arinç H, Abaci A, et al: Preload dependence of Doppler tissue imaging derived indexes of left ventricular diastolic function. Echocardiography 2005;22(4):320-25.
24. ) Pelà G, Regolisti G, Coghi P, 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 ; 5(4):262-71. ) Mendes L, Ribeiras R, Adragão T, et al: Load- independent parameters of diastolic and systolic function by speckle tracking and tissue doppler in hemodialysis patients. Rev Port Cardiol 2008; 27(9):1011-25.
25. ) Drighil A, Madias JE, Mathewson JW, El Mosalami H, El Badaoui N, Ramdani B, Bennis A. Haemodialysis: effects of acute decrease in preload on tissue Doppler imaging indices of systolic and diastolic function of the left and right ventricles. Eur J Echocardiogr. 2008; (4):530-5