The Role of Arteriovenous Shunt on Increased Prevalence of Unexplained Pulmonary Hypertension in Hemodialysis Patients
- Department of cardiology, Benha Faculty of Medicine, Benha University, Egypt.
- Department of cardiology, Zagazig Faculty of Medicine, Zagazige University, Egypt.
- Nephrology department, Benha Faculty of Medicine, Benha University, Egypt.
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Background: recent studies have shown a high incidence of unexplained pulmonary hypertension (PHT) in end-stage renal disease (ESRD) patients with or without haemodialysis (HD) therapy. The aim of this study was to evaluate the prevalence of unexplained PHT among patients with ESRD on regular HD and possible role of arteriovenous (AV) shunt as an etiological factor. Materials and methods: We enrolled 80 consecutive patients with ESRD on regular HD via AV shunt. Forty random chronic kidney disease (CKD) (predialysis) patients were taken up as a control. All patients underwent transthoracic echocardiography to assess the pulmonary artery pressure and cardiac output (CO). Pulmonary hypertension was defined as, pulmonary artery systolic pressure (PASP) greater than 35 mm Hg at rest. In HD patients with PHT, we reassessed CO and PASP before and after 1 minute of temporary compression over the AV shunt. Results: Patients on HD had higher PASP in comparison to control group. Out of 80 HD patients studied, 16 patients (20%) had PHT (PASP = 46±2 mmHg) while the rest had a normal PASP (29±1 mmHg) (P<0.0001). HD patients with PHT had significantly longer duration of dialysis (P<0.001), Higher CO in comparison to patients with no PHT (P<0.05). During AV shunt compression, the mean CO significantly decreased from (9.256±1.7538) L/min to (7.775±1.7842) L/min (P<0.001) and the mean PASP significantly decreased from (59.1644±17.28545) mmHg to (49.6300±14.91912) mmHg (P<0.001). Conclusion: Our study demonstrated a high prevalence of PHT among patients with ESRD receiving long-term HD with surgical AV shunt. Both ESRD and long-term HD may be involved in the pathogenesis of PHT by affecting pulmonary vascular resistance and CO. Pathological elevation of PAP occurs in those patients whose pulmonary circulation cannot compensate for AV access-related high CO. This unrecognized complication of HD therapy is not uncommon.
[Mohamed A. Tabl, Mohamed H. Ibrahim, EL Sayed M. Farag, Ahmed Wageh (2015); The Role of Arteriovenous Shunt on Increased Prevalence of Unexplained Pulmonary Hypertension in Hemodialysis Patients Int. J. of Adv. Res. 3 (Dec). 156-164] (ISSN 2320-5407). www.journalijar.com
