Prevalence of Right Ventricular Dysfunction & Pulmonary Hypertension and their Relationship to the Number of Hemodialysis Sessions in Patients of End-Stage Renal Disease (ESRD)

Abstract

Introduction: Chronic hemodialysis (HD) ends up with right ventricular (RV) dysfunction and increased pulmonary hypertension (PHTN). Left to right shunt in dialysis patients due to arterio-venous fistula (AVF) causes chronic volume overload, independent of rise in body water leading to worsening RV overload and RV dysfunction (RVD). Aims & Objectives: To determine the prevalence of RV dysfunction & pulmonary hypertension and its relationship to the number of dialysis sessions in patients of ESRD. Place and duration of study: Department of Cardiology & Nephrology, Sheikh Zayed Hospital, Lahore for one year from March 2016 - March 2017. Material & Methods: This cross-sectional analytical hospital based study enrolled 145 Patients of End-Stage Renal Disease (ESRD) on regular 4-hours HD sessions at two or more times per week for at least 3 months. Echocardiography (Echo) with 2-D, M (Motion) Mode & Doppler studies were done. RV dysfunction by TAPSE value less than 15mm & PHTN by Systolic pulmonary artery pressure >35 mm Hg or tricuspid regurgitation velocity (VTR) ?2m/s at rest were noted. Data was analyzed on SPSS version 20. Results: RV dysfunction was seen in 40.7% (59) of patients and the frequency rose across the 4 dialysis session groups (13.8%, 37.3%, 51.7% & 100%, p<0.001). PHTN was observed in 44.1% of the patients and the prevalence progressively increased across the groups (17.2%, 45.1%, 53.3% & 80.01%, p<0.003). There was significant association between RVD and PHTN (p=0.011). Conclusion: We observed positive correlation between RV dysfunction and PHTN with total number of hemodialysis sessions. Early detection of sub-clinical RV dysfunction may improve mortality and morbidity by optimizing treatment options.