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首页> 外文期刊>Kidney >The Role of Arterio-Venous Shunt in the Pathogenesis of Pulmonary Hypertention in Patients with End-stage Renal Disease
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The Role of Arterio-Venous Shunt in the Pathogenesis of Pulmonary Hypertention in Patients with End-stage Renal Disease

机译：动静脉分流在终末期肾脏疾病患者肺动脉高压发病中的作用

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Pulmonary hypertension (PHT) is an overlooked cardiovascular morbidity in patients with end stage renal disease. The pathogenesis of PHT in this group of patients is not explained satisfactorily. The aim of our study to evaluate the prevalence and the role of AV shunt in pathogenesis of pulmonary hypertention. Our study included 58 patients with ESRD without a known cause of PHT who were either in the predialysis period (stage 1V CKD) (14 patients) or maintained on chronic hemodialysis (stage V CKD) (44 patients) in Theodor Bilharz Research Institute (TBRI), Cairo, Egypt. In the chronic hemodialysis group, there were 27 males and 17 females with a mean age of 57.11 ± 12.31 years (range 28–65). In the predialysis group, there were 8 males and 6 females with a mean age 53.45 ± 9.41 years (range 28–66). Pulmonary arterial pressure (PAP) and cardiac output were evaluated by Doppler echocardiography in the 14 pre-dialysis patients without PHT few (4.3 ± 0.8) months after creation of AV fistula and in the 44 hemodialysis patients (33.6 ± 4.2 months) after creation of AV fistula within 1 h of completion of hemodialysis session. Arteriovenous fistula (AVF) flow was measured by Doppler sonography. PHT (systolic PAP ≥35 mm Hg) was observed in 25 (56.8%) patients receiving hemodialysis with a mean systolic PAP of 46.4 ± 13.6 mm Hg. In the predialysis group after creation of AV fistula, PHT was found in 6 (42.9%) patients with a mean systolic PAP of 42.8 ± 12.8 mm Hg. The cardiac output and AV shunt flow were found to be increased in patients with elevated systolic PAP in both groups (p < 0.05). CRF duration and AV fistula duration were positively correlated with systolic PAP in patients receiving hemodialysis (p < 0.05). After compression of AV fistula in 11 hemodialysis patients, the mean value of PHT decreased (from 43.98 ± 15.6 to 33.22 ± 11.7 mm Hg). This study demonstrates a high prevalence of PHT among patients with ESRD in predialysis period after creation of AV fistula and on chronic HD via a surgical A-V fistula. Cardiac output, AV shunt flow and duration, and ESRD duration may be involved in the pathogenesis of PHT. The development of PHT following access formation represents a failure of the pulmonary circulation to accommodate the access-mediated elevated CO. Pre-dialysis patients scheduled for access formation should be screened for the presence of sub-clinical PHT.
机译：肺动脉高压（PHT）是终末期肾脏疾病患者被忽视的心血管疾病。在这组患者中，PHT的发病机理尚未令人满意。我们研究的目的是评估AV分流在肺动脉高压发病中的发生率和作用。我们的研究包括Theodor Bilharz研究所（TBRI）的58例无已知PHT原因的ESRD患者，他们处于透析前期（1V CKD期）（14例）或接受慢性血液透析（V CKD期）（44例）。 ）， 开罗，埃及。在慢性血液透析组中，男性27例，女性17例，平均年龄为57.11±12.31岁（范围28-65）。在透析前组中，男8例，女6例，平均年龄53.45±9.41岁（范围28-66）。通过多普勒超声心动图对14例无PHT的前透析患者在造瘘后几（4.3±0.8）个月和44例血液透析的患者（33.6±4.2个月）进行了肺动脉压（PAP）和心输出量的评估。血液透析疗程结束后1小时内出现AV瘘。动静脉瘘（AVF）流量通过多普勒超声测量。在接受血液透析的25名（56.8％）患者中观察到PHT（收缩期PAP≥35 mm Hg），平均收缩期PAP为46.4±13.6 mm Hg。在AV瘘形成后的透析前组中，在6名（42.9％）患者中发现了PHT，其平均收缩期PAP为42.8±12.8 mm Hg。两组收缩压PAP升高的患者的心输出量和AV分流均增加（p <0.05）。接受血液透析的患者的CRF持续时间和AV瘘持续时间与收缩期PAP呈正相关（p <0.05）。在11例血液透析患者的AV瘘受压后，PHT的平均值下降了（从43.98±15.6降至3​​3.22±11.7 mm Hg）。这项研究表明，ESRD患者在创建AV瘘后的透析前期和通过手术A-V瘘进行慢性HD的人群中PHT的患病率较高。心输出量，AV分流和持续时间以及ESRD持续时间可能与PHT的发病机制有关。通路形成后PHT的发展代表肺循环无法适应通路介导的升高的CO。应对计划通路形成的透析前患者进行亚临床PHT的筛查。

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