Abstract
BackgroundIncreased right ventricular systolic pressure (RVSP), a surrogate marker for pulmonary hypertension, is common in patients with end-stage kidney disease. Limited data suggest improvement of RVSP with intensive dialysis, but it is unknown whether these improvements translate to better clinical outcomes.MethodsWe conducted a retrospective single center cohort study at the Toronto General Hospital. All patients who performed intensive home hemodialysis (IHHD) for at least a year between 1999 and 2017, and who had a baseline as well as a follow-up echocardiogram more than a year after IHHD, were included. Patients were categorized into two groups based on the RVSP at follow-up: elevated (≥ 35 mmHg) and normal RVSP. Multivariate and cox regression analyses were done to identify risk factors for elevated RVSP at follow-up and reaching the composite endpoint (death, cardiovascular hospitalization, treatment failure), respectively.ResultsOne hundred eight patients were included in the study. At baseline, 63% (68/108) of patients had normal RVSP and 37% (40/108) having elevated RVSP. After a follow-up of 4 years, 70% (76/108) patient had normal RVSP while 30% (32/108) had elevated RVSP. 8 (10%) out of the 76 patients with normal RVSP and 15 (47%) out of the 32 patients with elevated RVSP reached the composite endpoint of death, cardiovascular hospitalization or technique failure. In a multivariate analysis, age, diabetes and smoking were not associated with elevated RVSP at follow-up. Elevated RVSP at baseline was not associated with a higher likelihood in reaching the composite endpoint or mortality.ConclusionMean RVSP did not increase in patients on IHHD over time, and maintenance of normal RVSP was associated with better clinical outcomes.
Highlights
Increased right ventricular systolic pressure (RVSP), a surrogate marker for pulmonary hypertension, is common in patients with end-stage kidney disease
A study recently published by Santosh et al showed an increase over time in pulmonary artery systolic pressure in in-center hemodialysis as well as in peritoneal dialysis (PD) [2]
intensive home hemodialysis (IHHD) was defined as ≥16 h of dialysis per week based on the prescribed regimen at the end of home hemodialysis training
Summary
Increased right ventricular systolic pressure (RVSP), a surrogate marker for pulmonary hypertension, is common in patients with end-stage kidney disease. Right ventricular dysfunction and pulmonary hypertension (PH) are common in patients on conventional in-center hemodialysis) and have been reported in up to 50% [1]. A study recently published by Santosh et al showed an increase over time in pulmonary artery systolic pressure in in-center hemodialysis as well as in peritoneal dialysis (PD) [2] Both right ventricular dysfunction and PH, have been shown to be associated with adverse outcomes [3,4,5,6]. Studies of right ventricular function and pulmonary hypertension in patients undergoing intensive dialysis are limited. One study reported reduced left and right ventricular end systolic volumes in patients undergoing frequent in-center hemodialysis for 12 months [7]. There is a paucity of longitudinal studies detailing the impact of intensive hemodialysis on right ventricular function and structure
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