Pulmonary hypertension in hemodialysis patients: an unrecognized threat.

Abstract:

:Pulmonary hypertension (PH) is a progressive, fatal pulmonary circulatory disease that accompanies many conditions (including left to right side shunt) with compensatory elevated cardiac output. PH also complicates chronic hemodialysis (HD) therapy immediately after the creation of an arteriovenous (AV) access, even before starting HD therapy. It tends to regress after temporary AV access closure and after successful kidney transplantation. Affected patients have significantly higher cardiac output. This syndrome is associated with a statistically significant survival disadvantage. The laboratory hallmark of this syndrome is reduced basal and stimulatory nitric oxide (NO) levels. It appears that patients with end-stage renal disease (ESRD) acquire endothelial dysfunction that reduces the ability of their pulmonary vessels to accommodate the AV access-mediated elevated cardiac output, exacerbating the PH. Doppler echocardiographic screening of ESRD patients scheduled for HD therapy for the occurrence of PH is indicated. Early diagnosis enables timely intervention, currently limited to changing dialysis modality or referring for kidney transplantation.

journal_name

Semin Dial

journal_title

Seminars in dialysis

authors

Yigla M,Abassi Z,Reisner SA,Nakhoul F

doi

10.1111/j.1525-139X.2006.00186.x

subject

Has Abstract

pub_date

2006-09-01 00:00:00

pages

353-7

issue

5

eissn

0894-0959

issn

1525-139X

pii

SDI186

journal_volume

19

pub_type

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