Echocardiographic Finding in Chronic Kidney Disease Patients on Hemodialysis in Al-Diwaniyah Teaching Hospital
DOI:
https://doi.org/10.28922/qmj.v20i1.942Keywords:
Echocardiography finding, Ventricular hypertrophy, chronic kidney disease, hemodialysisAbstract
Background: Chronic kidney disease is irreversible deterioration of renal function which results into impairment of excretory, metabolic and endocrine functions leading to development of the clinical syndrome of uremia. Patients with Chronic kidney disease are at significantly increased risk for both morbidity and mortality from cardiovascular disease. Patients on dialysis have a 10- to 30-fold increased risk for cardiovascular mortality compared with the general population. Cardiovascular disease is the single most important cause of death among patients receiving long-term dialysis; accounting for 44% of overall mortality. The magnitude of the problem has become more apparent as patients now survive longer on maintenance dialysis.
Objective: To study various cardiovascular changes in chronic kidney disease patients on hemodialysis with help of 2D echocardiography.
Patients and Methods: A cross sectional study from tenth of March to the tenth of June of 2023 in Al- Zahraa dialysis center in Al-Diwaniyah teaching hospital. The study included 64 patients on hemodialysis, detailed history and examination were performed for every patient. The echocardiography examination was done for all involved patients and data was analyzed using SPSS version 26.
Results: the mean age and Body mass index was significantly higher among dialysis group. The family history of chronic kidney disease, diabetic mellitus, smoking history and history of hepatitis B, C were a risk factor that shown a significant difference between two groups. The mean serum level of Hb, calcium and phosphorous were significantly differing between two groups. Only 30% of patients on non-dialysis group had normal echo finding while 18.7% of patients on dialysis group had normal echo finding.
Conclusion: abnormal echo finding was more prominent among dialysis group, with most common abnormality was left ventricular hypertrophy fallowed by valvular disease
References
Skorecki K, Bargman J. Chronic Kidney Disease. Harrison's Principals of Internal Medicine. Newyork: McGraw-Hill Inc. 2012;18(2):2308.
Kovesdy CP. Epidemiology of chronic kidney disease: an update 2022. Kidney International Supplements. 2022;12(1):7-11. https://doi.org/10.1016/j.kisu.2021.11.003
Laddha M, Sachdeva V, Diggikar P, Satpathy P, Kakrani A. Echocardiographic assessment of cardiac dysfunction in patients of end stage renal disease on haemodialysis. J Assoc Physicians India. 2014;62(1):28-32. https://doi.org/10.15586/jrenhep.v5i1.98
Lesaffre F, Wynckel A, Nazeyrollas P, Rieu P, Metz D. Echocardiography to predict adverse cardiac and vascular events in patients with severe chronic kidney disease (stage 4): a prospective study. Archives of Cardiovascular Diseases. 2013;106(4):220-7. https://doi.org/10.1016/j.acvd.2013.01.005
Ostovan M, RAEIS JGA, MAZLOUM Z, ROUZBEH J, Sagheb M. Spectrum of echocardiographic abnormalities in end-stage renal disease patients undergoing hemodialysis. 2008.
Barberato SH, Pecoits-Filho R. Echocardiographic alterations in patients with chronic kidney failure undergoing hemodialysis. Arquivos brasileiros de cardiologia. 2010;94:140-6. https://doi.org/10.1590/S0066-782X2010000100021
Bethesda M. US Renal Data System: USRDS 2004 Annual Data Report: The National Institutes of Health. National Institute of Diabetes and Digestive and Kidney Diseases. 2004.
Ammirati AL. Chronic kidney disease. Revista da Associação Médica Brasileira. 2020;66:s03-s9. https://doi.org/10.1590/1806-9282.66.S1.3
Coresh J, Selvin E, Stevens LA, Manzi J, Kusek JW, Eggers P, et al. Prevalence of chronic kidney disease in the United States. Jama. 2007;298(17):2038-47. JAMA. 2007;298(17):2038-2047. doi:10.1001/jama.298.17.2038
Foreman KJ, Marquez N, Dolgert A, Fukutaki K, Fullman N, McGaughey M, et al. Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016–40 for 195 countries and territories. The Lancet. 2018;392(10159):2052-90. https://doi.org/10.1016/S0140-6736(18)31694-5
Lugon JR. Doença renal crônica no Brasil: um problema de saúde pública. J Bras Nefrol. 2009;31(1 suppl. 1):2-5. https://doi.org/10.1590/S0104-42302010000200028
Marinho AWGB, Penha AdP, Silva MT, Galvão TF. Prevalência de doença renal crônica em adultos no Brasil: revisão sistemática da literatura. Cadernos Saúde Coletiva. 2017;25:379-88. https://doi.org/10.1590/1414-462X201700030134
Thomé FS, Sesso RC, Lopes AA, Lugon JR, Martins CT. Brazilian chronic dialysis survey 2017. Brazilian Journal of Nephrology. 2019;41:208-14. https://doi.org/10.1590/2175-8239-JBN-2018-0178
Thomas B, Matsushita K, Abate KH, Al-Aly Z, Ärnlöv J, Asayama K, et al. Global cardiovascular and renal outcomes of reduced GFR. Journal of the American Society of Nephrology. 2017;28(7):2167-79.
Hill NR, Fatoba ST, Oke JL, Hirst JA, O’Callaghan CA, Lasserson DS, et al. Global prevalence of chronic kidney disease–a systematic review and meta-analysis. PloS one. 2016;11(7):e0158765. https://doi.org/10.1371/journal.pone.0158765
Jager KJ, Kovesdy C, Langham R, Rosenberg M, Jha V, Zoccali C. A single number for advocacy and communication—worldwide more than 850 million individuals have kidney diseases. Oxford University Press; 2019. p. 1803-5. https://doi.org/10.1093/ndt/gfz174
Erdei T, Aakhus S, Marino P, Paulus WJ, Smiseth OA, Fraser AG. Pathophysiological rationale and diagnostic targets for diastolic stress testing. Heart. 2015;101(17):1355-60. http://dx.doi.org/10.1136/heartjnl-2014-307040
Urlic H, Kumric M, Vrdoljak J, Martinovic D, Dujic G, Vilovic M, et al. Role of Echocardiography in Diabetic Cardiomyopathy: From Mechanisms to Clinical Practice. Journal of Cardiovascular Development and Disease. 2023;10(2):46. https://doi.org/10.3390/jcdd10020046
Gori M, Senni M, Gupta DK, Charytan DM, Kraigher-Krainer E, Pieske B, et al. Association between renal function and cardiovascular structure and function in heart failure with preserved ejection fraction. European heart journal. 2014;35(48):3442-51. https://doi.org/10.1093/eurheartj/ehu254
Tsilonis K, Sarafidis PA, Kamperidis V, Loutradis C, Georgianos PI, Imprialos K, et al. Echocardiographic parameters during long and short interdialytic intervals in hemodialysis patients. American Journal of Kidney Diseases. 2016;68(5):772-81. https://doi.org/10.1053/j.ajkd.2016.06.017
• 21. Zhu X, Jing R, Li X, Zhang W, Tang Y, Liu T. Left ventricular hypertrophy, carotid atherosclerosis, and cognitive impairment in peritoneal dialysis patients. BMC Cardiovascular Disorders. 2023;23(1):1-9. https://doi.org/10.1186/s12872-023-03130-0
Janjua TK, Mukhtar KN, Naveed AK, Ahmed EB, Rehan M. Frequency of maintenance hemodialysis patients meeting K/DOQI criteria for serum calcium, phosphorus, calcium phosphorus product and PTH levels; a single institutional experience from Pakistan: a cross sectional study. The Pan African Medical Journal. 2019;33.
Neugarten J, Golestaneh L, editors. Influence of sex on the progression of chronic kidney disease. Mayo Clinic Proceedings; 2019: Elsevier. https://doi.org/10.1016/j.mayocp.2018.12.024
Ricardo AC, Yang W, Sha D, Appel LJ, Chen J, Krousel-Wood M, et al. Sex-related disparities in CKD progression. Journal of the American Society of Nephrology. 2019;30(1):137-46.
• 25. Mohammedi K, Chalmers J, Herrington W, Li Q, Mancia G, Marre M, et al. Associations between body mass index and the risk of renal events in patients with type 2 diabetes. Nutrition & diabetes. 2018;8(1):7. https://doi.org/10.1038/s41387-017-0012-y
Vivante A, Golan E, Tzur D, Leiba A, Tirosh A, Skorecki K, et al. Body mass index in 1.2 million adolescents and risk for end-stage renal disease. Archives of internal medicine. 2012;172(21):1644-50. Arch Intern Med. 2012;172(21):1644-1650. doi:10.1001/2013.jamainternmed.85
Shahrin FIM, Yu LZ, Omar N, Zakaria NF, Daud ZAM. Association of socio-demographic characteristics, nutritional status, risk of malnutrition and depression with quality of life among elderly haemodialysis patients. Malaysian Journal of Nutrition. 2019;25(1). doi: https://doi.org/10.31246/mjn-2018-0101
Guerra-Guerrero V, Sanhueza-Alvarado O, Cáceres-Espina M. Quality of life in people with chronic hemodialysis: association with sociodemographic, medical-clinical and laboratory variables. Revista latino-americana de enfermagem. 2012;20:838-46. https://doi.org/10.1590/S0104-11692012000500004
Molsted S, Eidemak I. Musculoskeletal pain reported by mobile patients with chronic kidney disease. Clinical Kidney Journal. 2020;13(5):813-20. https://doi.org/10.1093/ckj/sfz196
• 30. Molsted S, Wendelboe S, Flege MM, Eidemak I. The impact of marital and socioeconomic status on quality of life and physical activity in patients with chronic kidney disease. International Urology and Nephrology. 2021:1-6. https://doi.org/10.1007/s11255-021-02826-6
Schouten RW, Haverkamp GL, Loosman WL, Shaw PKC, van Ittersum FJ, Smets YF, et al. Anxiety symptoms, mortality, and hospitalization in patients receiving maintenance dialysis: a cohort study. American Journal of Kidney Diseases. 2019;74(2):158-66. https://doi.org/10.1053/j.ajkd.2019.02.017
Song E-Y, McClellan WM, McClellan A, Gadi R, Hadley AC, Krisher J, et al. Effect of community characteristics on familial clustering of end-stage renal disease. American journal of nephrology. 2009;30(6):499-504. https://doi.org/10.1159/000243716
Adhikaree A, Amrit K, Triphatee A, Thakuri SBH, Thapa S, Regmi K, et al. Cardiac Evaluation of Chronic Kidney Disease Patients under Maintenance Hemodialysis. Nepal Journal of Medical Sciences. 2022;7(2):30-7.
Jameel FA, Junejo AM, ul ain Khan Q, Date S, Faraz A, Rizvi SHM, et al. Echocardiographic changes in chronic kidney disease patients on maintenance hemodialysis. Cureus. 2020;12(7).
• 35. Mirrakhimov AE. Obstructive sleep apnea and kidney disease: is there any direct link? Sleep and Breathing. 2012;16:1009-16. https://doi.org/10.1007/s11325-011-0624-8
Orth SR, Schroeder T, Ritz E, Ferrari P. Effects of smoking on renal function in patients with type 1 and type 2 diabetes mellitus. Nephrology Dialysis Transplantation. 2005;20(11):2414-9. https://doi.org/10.1093/ndt/gfi022
Nakhoul GN, Huang H, Arrigain S, Jolly SE, Schold JD, Nally Jr JV, et al. Serum potassium, end-stage renal disease and mortality in chronic kidney disease. American journal of nephrology. 2015;41(6):456-63. https://doi.org/10.1159/000437151
Moranne O, Froissart M, Rossert J, Gauci C, Boffa J-J, Haymann JP, et al. Timing of onset of CKD-related metabolic complications. Journal of the American Society of Nephrology. 2009;20(1):164-71.
El-Reshaid W, Abdul-Fattah H. Sonographic assessment of renal size in healthy adults. Medical principles and practice. 2014;23(5):432-6. https://doi.org/10.1159/000364876
Beland MD, Walle NL, Machan JT, Cronan JJ. Renal cortical thickness measured at ultrasound: is it better than renal length as an indicator of renal function in chronic kidney disease? American Journal of Roentgenology. 2010;195(2):W146-W9. https://doi.org/10.2214/AJR.09.4104
Korkmaz M, Aras B, Güneyli S, Y?lmaz M. Clinical significance of renal cortical thickness in patients with chronic kidney disease. Ultrasonography. 2018;37(1):50.
Fujii H, Joki N. Mineral metabolism and cardiovascular disease in CKD. Clinical and experimental nephrology. 2017;21:53-63https://link.springer.com/article/10.1007/s10157-016-1363-8#citeas:~:text=DOI-,https%3A//doi.org/10.1007/s10157%2D016%2D1363%2D8,-Keywords.
Matsuo H, Dohi K, Machida H, Takeuchi H, Aoki T, Nishimura H, et al. Echocardiographic assessment of cardiac structural and functional abnormalities in patients with end-stage renal disease receiving chronic hemodialysis. Circulation Journal. 2018;82(2):586-95. https://doi.org/10.1253/circj.CJ-17-0393
Ku?ma ?, Ma?yszko J, Bachórzewska-Gajewska H, Niwi?ska MM, Kurasz A, Zalewska-Adamiec M, et al. Impact of chronic kidney disease on long-term outcome of patients with valvular heart defects. International Urology and Nephrology. 2020;52:2161-70. https://link.springer.com/article/10.1007/s11255-020-02561-4#citeas:~:text=DOI-,https%3A//doi.org/10.1007/s11255%2D020%2D02561%2D4,-Share%20this%20article
Marwick TH, Amann K, Bangalore S, Cavalcante JL, Charytan DM, Craig JC, et al. Chronic kidney disease and valvular heart disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney international. 2019;96(4):836-49. https://doi.org/10.1016/j.kint.2019.06.025
Hensen LC, El Mahdiui M, van Rosendael AR, Smit JM, Jukema JW, Bax JJ, et al. Prevalence and prognostic implications of mitral and aortic valve calcium in patients with chronic kidney disease. The American Journal of Cardiology. 2018;122(10):1732-7. https://doi.org/10.1016/j.amjcard.2018.08.009
Park M, Hsu C-y, Li Y, Mishra RK, Keane M, Rosas SE, et al. Associations between kidney function and subclinical cardiac abnormalities in CKD. Journal of the American Society of Nephrology. 2012;23(10):1725-34.
Fearnley CJ, Roderick HL, Bootman MD. Calcium signaling in cardiac myocytes. Cold Spring Harbor perspectives in biology. 2011;3(11):a004242. Cold Spring Harb Perspect Biol 2011; doi: 10.1101/cshperspect.a004242 originally published online
London GM. Left ventricular alterations and end?stage renal disease. Nephrology Dialysis Transplantation. 2002;17(suppl_1):29-36. https://doi.org/10.1093/ndt/17.suppl_1.29
Wang AY, Wang M, Lam CW, Chan IH, Zhang Y, Sanderson JE. Left ventricular filling pressure by Doppler echocardiography in patients with end-stage renal disease. Hypertension. 2008;52(1):107-14. https://doi.org/10.1161/HYPERTENSIONAHA.108.112334
Takase H, Dohi Y, Toriyama T, Okado T, Tanaka S, Shinbo H, et al. B-type natriuretic peptide levels and cardiovascular risk in patients with diastolic dysfunction on chronic haemodialysis: cross-sectional and observational studies. Nephrology Dialysis Transplantation. 2011;26(2):683-90. https://doi.org/10.1093/ndt/gfq408
Sharma R, Gaze DC, Pellerin D, Mehta R, Gregson H, Streather CP, et al. Cardiac structural and functional abnormalities in end stage renal disease patients with elevated cardiac troponin T. Heart. 2006;92(6):804-9. http://dx.doi.org/10.1136/hrt.2005.069666
Rakhit DJ, Zhang XH, Leano R, Armstrong KA, Isbel NM, Marwick TH. Prognostic role of subclinical left ventricular abnormalities and impact of transplantation in chronic kidney disease. American heart journal. 2007;153(4):656-64. https://doi.org/10.1016/j.ahj.2007.01.028
Farshid A, Pathak R, Shadbolt B, Arnolda L, Talaulikar G. Diastolic function is a strong predictor of mortality in patients with chronic kidney disease. BMC nephrology. 2013;14(1):1-6. https://bmcnephrol.biomedcentral.com/articles/10.1186/1471-2369-14-280#citeas:~:text=DOI-,https%3A//doi.org/10.1186/1471%2D2369%2D14%2D280,-Share%20this%20article
Dad T, Sarnak MJ, editors. Pericarditis and pericardial effusions in end?stage renal disease. Seminars in Dialysis; 2016: Wiley Online Library. https://doi.org/10.1111/sdi.12517
Ravi V, Iskander F, Saini A, Brecklin C, Doukky R. Clinical predictors and outcomes of patients with pericardial effusion in chronic kidney disease. Clinical Cardiology. 2018;41(5):660-5. https://doi.org/10.1002/clc.22946
Aghsaeifard Z, Firouzi R, Alizadeh R. Predisposing factors and uremic pericardial effusion among ESRD patients undergoing dialysis. Annals of Medicine and Surgery. 2022;77:103579https://doi.org/10.1016/j.amsu.2022.103579.
Nazneen S, Latief M, Yadla M. Echocardiographic Changes in Patients with End-Stage Renal Disease at Initiation of Dialysis. Journal of Renal and Hepatic Disorders. 2021;5(1):44-8. https://doi.org/10.15586/jrenhep.v5i1.98
Kartheek AV, Reddy VS. Assessment of cardiac dysfunction in patients with end stage renal disease in a tertiary care hospital. J Evid Based Med Health. 2019;6(24):1668-72.
Escoli R, Carvalho MJ, Cabrita A, Rodrigues A. Diastolic dysfunction, an underestimated new challenge in dialysis. Therapeutic Apheresis and Dialysis. 2019;23(2):108-17. https://doi.org/10.1111/1744-9987.12756
