Document Detail


Pulmonary hypertension in chronic dialysis patients with arteriovenous fistula: pathogenesis and therapeutic prospective.
MedLine Citation:
PMID:  16775448     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE OF REVIEW: End-stage renal disease patients receiving chronic haemodialysis via arteriovenous access often develop various cardiovascular complications, including vascular calcification, cardiac-vascular calcification and atherosclerotic coronary disease. This review describes recently published studies that demonstrate a high incidence of pulmonary hypertension among patients with end-stage renal disease receiving long-term haemodialysis via a surgical arteriovenous fistula. Both end-stage renal disease and long-term haemodialysis via arteriovenous fistula may be involved in the pathogenesis of pulmonary hypertension by affecting pulmonary vascular resistance and cardiac output. RECENT FINDINGS: Morbidity and mortality from cardiovascular disease are greatly increased in patients on maintenance haemodialysis therapy. Using Doppler echocardiography, we found a significant increase in cardiac output in 40% of chronic haemodialysis patients, probably related to the large arteriovenous access or altered vascular resistance as a result of the local vascular tone and function expressed by the imbalance between vasodilators such as nitric oxide, and vasoconstrictors such as endothelin-1. SUMMARY: We propose different potential mechanisms as explanations for the development of pulmonary hypertension. Hormonal and metabolic derangement associated with end-stage renal disease might lead to pulmonary arterial vasoconstriction and an increase in pulmonary vascular resistance. Pulmonary arterial pressure may be further increased by high cardiac output resulting from the arteriole-venous access itself, worsened by commonly occurring anaemia and fluid overload.
Authors:
Zaid Abassi; Farid Nakhoul; Eliyahu Khankin; Shimon A Reisner; Mordechai Yigla
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Current opinion in nephrology and hypertension     Volume:  15     ISSN:  1062-4821     ISO Abbreviation:  Curr. Opin. Nephrol. Hypertens.     Publication Date:  2006 Jul 
Date Detail:
Created Date:  2006-06-15     Completed Date:  2006-11-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9303753     Medline TA:  Curr Opin Nephrol Hypertens     Country:  England    
Other Details:
Languages:  eng     Pagination:  353-60     Citation Subset:  IM    
Affiliation:
Department of Physiology and Biophysics, Rappaport Family Institute for Research in the Medical Sciences, Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Technion City, Israel.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Blood Pressure
Calcinosis / etiology,  metabolism,  mortality,  pathology,  therapy
Cardiac Output
Echocardiography, Doppler / methods
Endothelin-1 / metabolism
Female
Humans
Hypertension, Pulmonary* / etiology,  metabolism,  mortality,  pathology,  therapy
Kidney Failure, Chronic* / complications,  metabolism,  mortality,  pathology,  therapy
Male
Middle Aged
Nitric Oxide / metabolism
Pulmonary Artery / metabolism,  physiopathology
Renal Dialysis / adverse effects
Time Factors
Vascular Resistance
Vasoconstrictor Agents / metabolism
Vasodilator Agents / metabolism
Chemical
Reg. No./Substance:
0/Endothelin-1; 0/Vasoconstrictor Agents; 0/Vasodilator Agents; 10102-43-9/Nitric Oxide

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