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Unexplained pulmonary hypertension in peritoneal dialysis and hemodialysis patients

Publicado na Rev Port Pneumol. 2012;18:10-4. - vol.18 núm 01

Resumo

Objetivos

Comparar a prevalência de hipertensão arterial pulmonar (PAH) inexplicável em doentes sob hemodiálise (HD) e diálise peritoneal (PD) e comparar os parâmetros laboratoriais entre doentes com PAH inexplicável e aqueles com pressão arterial pulmonar normal (PAP).

Métodos

Revimos, de forma retrospetiva, os registos médicos de 278 doentes com HD crónica e 145 com PD crónica. Dos dados laboratoriais foram registadas hemoglobina, cálcio, fósforo, fosfatase alcalina, albumina, nível de paratormona, ferro sérico, capacidade total de ligação de ferro, ferritina, creatinina e nitrogénio ureico no sangue. Os resultados do ecocardiograma doppler transtorácico foram utilizados para determinar a pressão arterial pulmonar (PAP). A PAH foi definida como uma pressão arterial pulmonar sistólica (SPAP) ≥35mmHg. Para excluir a PAH secundária, foram excluídos os pacientes com problemas cardíacos, doenças pulmonares, doenças vasculares do colagénio, excesso de volume na altura do ecocardiograma e vírus de imunodeficiência humana positivo.

Resultados

Foram analisados dados de 34 pacientes no HD e 32 indivíduos no grupo PD. A mediana de idade da população estudada foi de 57 (45–68) anos. O valor médio de SPAP em doentes com PAH foi de 37,5 (35–45) mmHg. De acordo com os resultados do ecocardiograma, a PAH foi registada em 14 (41,1%) pacientes do grupo HD e em 6 (18,7%) pacientes do grupo PD (P=0,04). A mediana do ferro sérico médio e da hemoglobina estavam significativamente mais baixos em pacientes com PAH em comparação com os pacientes com PAP normal (P<0,05).

Conclusão

A PAH inexplicável parece ser mais frequente em pacientes com HD do que em pacientes no grupo de PD. Além disso, os níveis de hemoglobina e ferro sérico são inferiores em pacientes com PAH comparando com os do grupo de PAP normal.

Palavras-chave: Hipertensão arterial pulmonar inexplicável. Diálise peritoneal. Hemodiálise.

Introdução

Introduction Pulmonary arterial hypertension (PAH) is a newly recognized disease in patients with renal disease.1 In clinical practice, shunting of blood from the left to the right side of the heart and increased cardiac output and pulmonary blood flow are common medical conditions resulting in PAH.2 However, Yigla et al. first noted unexplained PAH in some long-term hemodialysis (HD) patients during an epidemiologic study.3 They attributed both end stage renal disease (ESRD) and long-term HD therapy via an arteriovenous (AV) access to the pathogenesis of PAH in these patients.3, 4 On the other hand, the prevalence of PAH in patients on peritoneal dialysis (PD) is still a matter of debate.5, 6 The information in the literature regarding unexplained or primary PAH in ESRD patients especially PD patients is limited. Therefore, the aim of the present study was to compare the prevalence of unexplained PAH in HD and PD patients. In addition, we aimed to compare laboratory parameters between patients with unexplained PAH and those with normal pulmonary artery pressure (PAP). Materials and methods We retrospectively reviewed the medical records of 278 chronic HD and 145 chronic PD patients treated at the hospitals affiliated to the university in Tabriz, Iran between May 2008 and January 2010. The patients’ data including age, sex, co-morbidities, medications, tobacco use, etiology of renal failure, vascular access type, and duration of dialysis therapy were recorded. Laboratory findings including hemoglobin, calcium, phosphorus, alkaline phosphatase, albumin, parathyroid hormone (PTH) level, serum iron, total iron binding capacity, ferritin, creatinine and blood urea...

Bibliografia

1. Unal A, Tasdemir K, Oymak S, Duran M, Kocyigit I, Oguz F, et-al. The long-term effects of arteriovenous fistula creation on the development of pulmonary hypertension in hemodialysis patients. Hemodial Int. 2010; 14:398-402.
Pubmed
2. Farber HW, Loscalzo J. Pulmonary arterial hypertension. N Engl J Med. 2004; 351:1655-65.
Pubmed
3. Yigla M, Dabbah S, Azzam ZS, Rubin AH, Reisner SA. Background diseases in 671 patients with moderate to severe pulmonary hypertension. Isr Med Assoc J. 2000; 2:684-9.
Pubmed
4. Yigla M, Nakhoul F, Sabag A, Tov N, Gorevich B, Abassi Z, et-al. Pulmonary hypertension in patients with end-stage renal disease. Chest. 2003; 123:1577-82.
Pubmed
5. Kumbar L, Fein PA, Rafiq MA, Borawski C, Chattopadhyay J, Avram MM. Pulmonary hypertension in peritoneal dialysis patients. Adv Perit Dial. 2007; 23:127-31.
Pubmed
6. Bozbas SS, Akcay S, Altin C, Bozbas H, Karacaglar E, Kanyilmaz S, et-al. Pulmonary hypertension in patients with end-stage renal disease undergoing renal transplantation. Transplant Proc. 2009; 41:2753-6.
Pubmed
7. Amin M, Fawzy A, Hamid MA, Elhendy A. Pulmonary hypertension in patients with chronic renal failure: role of parathyroid hormone and pulmonary artery calcifications. Chest. 2003; 124:2093-7.
Pubmed
8. Tarrass F, Benjelloun M, Medkouri G, Hachim K, Benghanem MG, Ramdani B. Doppler echocardiograph evaluation of pulmonary hypertension in patients undergoing hemodialysis. Hemodial Int. 2006; 10:356-9.
Pubmed
9. Nakhoul F, Yigla M, Gilman R, Reisner SA, Abassi Z. The pathogenesis of pulmonary hypertension in haemodialysis patients via arterio-venous access. Nephrol Dial Transplant. 2005; 20:1686-92.
Pubmed
10. Havlucu Y, Kursat S, Ekmekci C, Celik P, Serter S, Bayturan O, et-al. Pulmonary hypertension in patients with chronic renal failure. Respiration. 2007; 74:503-10.
Pubmed
11. Mahdavi-Mazdeh M, Alijavad-Mousavi S, Yahyazadeh H, Azadi M, Yoosefnejad H, Ataiipoor Y. Pulmonary hypertension in hemodialysis patients. Saudi J Kidney Dis Transpl. 2008; 19:189-93.
Pubmed
12. Abassi Z, Nakhoul F, Khankin E, Reisner SA, Yigla M. Pulmonary hypertension in chronic dialysis patients with arteriovenous fistula: pathogenesis and therapeutic prospective. Curr Opin Nephrol Hypertens. 2006; 15:353-60.
Pubmed
13. Ruiter G, Lankhorst S, Boonstra A, Postmus PE, Zweegman S, Westerhof N, et-al. Iron deficiency is common in idiopathic pulmonary arterial hypertension. Eur Respir J. 2011; 37:1386-91.
Pubmed
14. Akmal M, Barndt RR, Ansari AN, Mohler JG, Massry SG. Excess PTH in CRF induces pulmonary calcification, pulmonary hypertension and right ventricular hypertrophy. Kidney Int. 1995; 47:158-63.
Pubmed
15. Yigla M, Keidar Z, Safadi I, Tov N, Reisner SA, Nakhoul F. Pulmonary calcification in hemodialysis patients: correlation with pulmonary artery pressure values. Kidney Int. 2004; 66:806-10.
Pubmed
16. Vaziri ND. Effect of chronic renal failure on nitric oxide metabolism. Am J Kidney Dis. 2001; 38:S74-9.
Pubmed
17. Schmidt RJ, Yokota S, Tracy TS, Sorkin MI, Baylis C. Nitric oxide production is low in end-stage renal disease patients on peritoneal dialysis. Am J Physiol. 1999; 276:F794-7.
Pubmed
18. Yigla M, Abassi Z, Reisner SA, Nakhoul F. Pulmonary hypertension in hemodialysis patients: an unrecognized threat. Semin Dial. 2006; 19:353-7.
Pubmed
19. Dschietzig T, Richter C, Bartsch C, Böhme C, Heinze D, Ott F, et-al. Flow-induced pressure differentially regulates endothelin-1, urotensin II, adrenomedullin, and relaxin in pulmonary vascular endothelium. Biochem Biophys Res Commun. 2001; 289:245-51.
Pubmed
20. Barak M, Katz Y. Microbubbles: pathophysiology and clinical implications. Chest. 2005; 128:2918-32.
Pubmed
21. Farber HW, Foreman AJ, Miller DP, McGoon MD. REVEAL registry: correlation of right heart catheterization and echocardiography in patients with pulmonary arterial hypertension. Congest Heart Fail. 2011; 17:56-64.
Pubmed
22. Marangoni S, Quadri A, Dotti A, Scalvini S, Volterrani M, Schena M, et-al. Noninvasive assessment of pulmonary hypertension: a simultaneous echo-Doppler hemodynamic study. Cardiology. 1988; 75:401-8.
Pubmed

Etemadi, J.a; Zolfaghari, H.b; Firoozi, R.c; Ardalan, M.R.a; Toufan, M.c; Shoja, M.M.d; Ghabili, K.e

aDepartment of Nephrology, Dialysis and Transplantation, Tabriz University of Medical Sciences, Tabriz, Iran

bFaculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

cDepartment of Cardiology, Tabriz University of Medical Sciences, Tabriz, Iran

dMedical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

eTuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran