Российское диализное общество

Просмотр статьи

<< Вернуться к списку статей журнала

Том 21 №1 2019 год - Нефрология и диализ

Роль артериовенозной фистулы в формировании легочной гипертензии у пациентов на заместительной почечной терапии. Обзор литературы


Исхаков Р.Т. Зелтынь-Абрамов Е.М. Потешкина Н.Г. Белавина Н.И.

DOI: 10.28996/2618-9801-2019-1-19-31

Аннотация: Легочная гипертензия (ЛГ) представляет собой сложный патофизиологический и клинический феномен, характеризующийся прогрессирующим повышением давления в легочной артерии (ДЛА). Рост ДЛА может привести к необратимым структурным изменениям легочного сосудистого русла. Клиническим проявлением патоморфологических изменений является формирование тяжелой, часто необратимой, правожелудочковой недостаточности. ЛГ широко распространена среди пациентов с продвинутыми стадиями хронической болезни почек (ХБП), в том числе, получающих заместительную почечную терапию (ЗПТ), являясь независимым предиктором летальности и сердечно-сосудистых осложнений в данной популяции. Патогенетические механизмы формирования ЛГ у пациентов на ЗПТ многообразны и остаются предметом дискуссии. В ряде случаев в качестве причины формирования ЛГ выступают заболевания, коморбидные диализ-потребной ХБП или непосредственно приведшие к ее развитию. Однако в настоящее время внимание экспертов сосредоточено на изучении нейрогуморальных и гемодинамических паттернов развития ЛГ, связанных как с особенностями патоморфоза ХБП, так и с воздействием функционирующей артериовенозной фистулы (АВФ) на центральную гемодинамику. Уточнение гемодинамических аспектов формирования ЛГ у пациентов с АВФ и выработка доказательных лечебных и обсервационных стратегий невозможны без дальнейшего определения влияния АВФ per se на сердечно-сосудистую систему конкретного пациента. Диагностический подход к оценке вероятных клинических сценариев включает в себя этапное эхо-кардиографическое наблюдение, катетеризацию правых отделов сердца, пробу временной окклюзии АВФ. Все диагностические маневры следует проводить с учетом закономерных колебаний волемического статуса пациента, находящегося на программном гемодиализе. Корректная методологическая оценка вклада АВФ в формирование ЛГ позволит сформулировать конкретные лечебные стратегии в диапазоне от реконструкции сосудистого доступа до смены вида ЗПТ.

Весь текст

Ключевые слова: легочная гипертензия, артериовенозная фистула, сердечная недостаточность с высоким сердечным выбросом, заместительная почечная терапия

Список литературы:
  1. Nakhoul F., Yigla M., Gilman R. et al. The pathogenesis of pulmonary hypertension in haemodialysis patients via arterio-venous access. Nephrol Dial Transplant 2005; 20:1686-1692.
  2. Yigla M., Fruchter O., Aharonson D. et al. Pulmonary hypertension is an independent predictor of mortality in hemodialysis patients. Kidney Int 2009; 75:969-975.
  3. Yigla M., Nakhoul F., Sabag A. et al. Pulmonary hypertension in patients with end-stage renal disease. Chest 2003; 123:1577-1582.
  4. Tuder R.M., Stacher E., Robinson J. et al. Pathology of pulmonary hypertension. Clin Chest Med. 2013; 34(4):639-650.
  5. Ronco C. Cardiorenal and renocardiac syndromes: clinical disorders in search of a systematic definition. Int J Artif Organs 2008; 31:1-2.
  6. Ronco C., Di Lullo L. Cardiorenal Syndrome in Western Countries: Epidemiology, Diagnosis and Management Approaches Kidney Dis 2016; 2:151-163.
  7. Scabbia E. V., Scabbia L. The Cardio-renal Syndrome (CRS) IJC Metabolic & Endocrine, Vol. 9, 2015;1-4.
  8. Hatano S., Strasser T. Primary Pulmonary Hypertension. Geneva: World Health Organization; 1975. p. 2012. Report on a WHO Meeting. October 15-17, 1973.
  9. Fishman A.P. Clinical classification of pulmonary hypertension. Clin Chest Med 2001; 22:385-91.
  10. Galiè N., Humbert M., Vachiery J-L., Gibbs S., Lang I., Torbicki A., Simonneau G., Peacock A., Noordegraaf A.V., Beghetti M., Ghofrani A., Gomez Sanchez M.A., Hansmann G., Klepetko W., Lancellotti P., Matucci M., McDonagh T., Pierard L.A., Trindade P.T., Zompatori M., Hoeper M. ESC Scientific Document Group; 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT), Eur Heart J 2016; 37(1): 67-119.
  11. Simonneau G., Robbins I.M., Beghetti M. et al. Updated clinical classification of pulmonary hypertension. J Am Coll Cardiol 2009; 54:43-54.
  12. Hatle L., Angelsen B.A., Tromsdal A. Non-invasive estimation of pulmonary artery systolic pressure with Doppler ultrasound. Br Heart J 1981; 45(2):157-65.
  13. McQuillan B.M., Picard M.H., Leavitt M., Weyman A.E. Clinical correlates and reference intervals for pulmonary artery systolic pressure among echocardiographically normal subjects. Circulation 2001; 104(23):2797-80.
  14. Rudski L.G., Lai W.W., Afilalo J., Hua L., Handschumacher M.D., Chandrasekaran K., Solomon S.D., Louie E.K., Schiller N.B. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010; 23:685-713.
  15. Greiner S., Jud A., Aurich M. Reliability of noninvasive assessment of systolic pulmonary artery pressure by Doppler echocardiography compared to right heart catheterization: analysis in a large patient population. J Am Heart Assoc. 2014; 21;3(4):e001103.
  16. Guillinta P., Peterson K.L., Ben-Yehuda O. Cardiac catheterization techniques in pulmonary hypertension. Cardiol. Clin. 2004; 22:401-405.
  17. Hoeper M.M., Bogaard H.J., Condliffe R. et al. Definitions and diagnosis of pulmonary hypertension. J Am Coll Cardiol 2013; 62(Suppl):42-50.
  18. Oudiz R.J., Langleben D. Cardiac catheterization in pulmonary arterial hypertension: An updated guide to proper use. Adv. Pulm. Hypertens. 2005; 4: 15-25.
  19. Swan H.J., Ganz W., Forrester J.et al. Catheterization of the heart in man with use of a flow-directed balloon-tipped catheter. N. Engl. J. Med. 1970; 283:447-451.
  20. Легочная гипертензия С.Н. Авдеев и др. М.: ГЭОТАР-Медиа, 2015. 416 с.
  21. Davidson C.J., Bonow R.O. Cardiac catheterization. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Vol. 1 Eds P. Libby, R.O. Bonow, D.L. Mann, D.P. Zipes. Philadelphia: Saunders, 2007. P. 439-463.
  22. Kelly C.R., Rabbani L.E. Pulmonary-artery catheterization. N. Engl. J. Med. 2013; 369:е35.
  23. Summerhill E.M., Baram M. Principles of pulmonary artery catheterization in the critically ill. Lung 2005; 183:209-219.
  24. Farber H.W., Foreman A.J., Miller D.P. et al. REVEAL Registry: correlation of right heart catheterization and echocardiography in patients with pulmonary arterial hypertension. Congest Heart Fail. 2011; 17:56-64.
  25. Fisher M.R., Forfia P.R., Chamera E. et al. Accuracy of Doppler echocardiography in the hemodynamic assessment of pulmonary hypertension. Am J Respir Crit Care Med. 2009; 179:615-621.
  26. Yock P.G., Popp R.L. Noninvasive estimation of right ventricular systolic pressure by Doppler ultrasound in patients with tricuspid regurgitation. Circulation. 1984; 70:657-662.
  27. Reque J., Quiroga B., Ruiz C. et al. Pulmonary hypertension is an independent predictor of cardiovascular events and mortality in haemodialysis patients. Nephrology (Carlton). 2016; 21(4):321-326.
  28. Agarwal R. Prevalence, determinants and prognosis of pulmonary hypertension among hemodialysis patients. Nephrol Dial Transplant 2012; 27:3908-3914.
  29. Amin M., Fawzy A., Hamid M.A. et al. Pulmonary hypertension in patients with chronic renal failure: role of parathyroid hormone and pulmonary artery calcifications. Chest 2003; 124: 2093-2097.
  30. Fabbian F., Cantelli S., Molino C. et al. Pulmonary hypertension in dialysis patients: a cross-sectional Italian study. Int J Nephrol 2011; 28-34.
  31. Ramasubbu K., Deswal A., Herdejurgen C. et al. A prospective echocardiographic evaluation of pulmonary hypertension in chronic hemodialysis patients in the United States: prevalence and clinical significance. Int J Gen Med 2010; 3:279-286.
  32. Bolignano D., Lennartz S., Leonardis D. et al. High estimated pulmonary artery systolic pressure predicts adverse cardiovascular outcomes in stage 2-4 chronic kidney disease. Kidney Int. 2015; 88:130-136.
  33. Di Lullo L., Floccari F., Rivera R. et al. Pulmonary Hypertension and Right Heart Failure in Chronic Kidney Disease: New Challenge for 21st-Century Cardionephrologists. Cadiorenal Med 2013; 3:96-103.
  34. Zoccali C. Pulmonary hypertension in dialysis patients: a prevalent, risky but still uncharacterized disorder. Nephrol Dial Transplant 2012; 27:3674-3677.
  35. Sofia M., Stanziola A.A. Kidney pulmonary hypertension: another road on the map? Multidisc Resp Med 2011; 6(3):150-152.
  36. Зелтынь-Абрамов Е.М., Котенко О.Н., Андрусев А.М. и др. Сердечная недостаточность с высоким сердечным выбросом у пациентки на программном гемодиализе. Нефрология и диализ.
  37. Alhamad N.E., Al-Ghonaim M., Alfaleh H.F. et al. Pulmonary hypertension in end-stage renal disease and post renal transplantation patients J Thorac Dis 2014; 6(6):606-16.
  38. Babadjanov J., Miler R., Niebauer K., Kirksey L. Arteriovenous Fistula Creation for End-Stage Renal Disease May Worsen Pulmonary Hypertension. Ann Vasc Surg. 2016; 36:293.
  39. Pabst S., Hammerstingl C., Hundt F. Pulmonary hypertension in end-stage renal disease: three case reports. Dtsch Med Wochenschr. 2011;136(18):944-7.
  40. Ragupathi L., Johnson D., Marhefka G.D. Right Ventricular Enlargement within Months of Arteriovenous Fistula Creation in 2 Hemodialysis Patients. Tex Heart Inst J. 2016 1;43(4):350-3.
  41. Riolo G., Bader B. A., D`Arsigny Ch. Pulmonary hypertension: Tortuous route to diagnosis. Respirol Case Rep 2013; 1(1): 8-9.
  42. Зелтынь-Абрамов Е.М., Исхаков Р.Т., Артюхина Л.Ю. и др. Обратимая легочная гипертензия у пациентки после трансплантации почки с длительно функционирующей артериовенозной фистулой. Вестник трансплантологии и искусственных органов 2017; 19(1):57-62.
  43. Bertrand D., Desbuissons G., Pallet N. et al. Acute renal failure and volume overload syndrome secondary to a femoro-femoral arteriovenous fistula angioplasty in kidney transplant recipient. Case Rep in Transpl 2013; ID 197524.
  44. Bozbas S.S., Akcay S., Altin C. et al. Pulmonary hypertension in patients with end-stage renal disease undergoing renal transplantation 2009; 41:2753-2756.
  45. Kabitz H-J., Walterspacher S., Geyer M. et al. Reversible pulmonary hypertension in a kidney transplant with patent A-V fistula Clin Kidney J 2012; 5(4): 347-9.
  46. Rao N., Worthley M., Disney P., Faull R. Dramatic improvement in decompensated right heart failure due to severe tricuspid regurgitation following ligation of arteriovenous fistula in a renal transplant recipient. Semin Dial 2014;27(2):E24-6.
  47. Movilli E., Viola B. F., Brunori G. et al. Long-term effects of AVF closure on echocardiographic functional and structural findings in HD patients: a prospective study. Am J Kidney Dis 2010; 55:682-689.
  48. De Lima J.J., Vieira M.L.C., Molnar L.J. et al. Cardiac effects of persistent hemodialysis arteriovenous access in recipient of renal allograft. Cardiology 1999; 92:236-39.
  49. Savage M.T., Ferro C.J., Sassano A. et al. The impact of arteriovenous fistula formation on central hemodynamic pressures in chronic renal failure patients: a prospective study. Am J Kidney Dis 2002; (40):753-9.
  50. Van Dujnhover E.C.M., Cheriex E.C.M., Tordoir J.H.M. et al. Effect of closure of the arteriovenous fistula on left ventricular dimensions in renal transplant patients. Nephrol Dial Transplant 2001; 16: 368-72.
  51. Manca O., Pisano G.L., Carta P. et al. The management of haemodialysis arteriovenous fistulas in well-functioning renal transplanted patients: Many doubts, few certainties. J Vasc Acc 2005; 6:182-86.
  52. Cridlig J., Selton-Suty Ch., Alla F. Cardiac impact of the arteriovenous fistula after kidney transplantation: a case-controlled, match-paired study. Transplant 2008; 21:948-954.
  53. Casas-Aparicio G., Castillo-Martinez L., Orea-Tejeda A. et al. The effect of Successful Kidney Transplantation on ventricular Dysfunction and Pulmonary Hypertention. Transplant Proc 2010; 42:3524-8.
  54. Bozbas S.S., Kanyilmaz S., Akcay S. et al. Renal transplant improves pulmonary hypertension in patients with end stage renal disease. Multidiscipl Resp Med 2011; 6(3):155-60.
  55. Abassi Z., Nakhoul F., Khankin E. et al. Pulmonary hypertension in chronic dialysis patients with arteriovenous fistula: pathogenesis and therapeutic prospective. Curr Opin Nephrol Hypertens 2006; 15:353-360.
  56. Issa N., Krowka M.G., Griffin M.D. et al. Pulmonary hypertension in associated with reduced patient survival after kidney transplantation. Transplantation 2008; 86:1384-1388.
  57. Pabst S., Hammersting C., Hundt F. et al. Pulmonary hypertension in patients with chronic kidney disease on dialysis and without dialysis: results of the PEPPER-study. PLoS One. 2012; 7:e35310.
  58. Abedini M., Sadeghi M., Naini A.E. et al. Pulmonary hypertension among patients on dialysis and kidney transplant recipients Ren Fail 2013; 35:560-65.
  59. Beigi A.A., Sadeghi A.M.M., Khosravi A.R. et al. Effects of the arteriovenous fistula on pulmonary artery pressure and cardiac output in patients with chronic renal failure. J Vasc Access. 2009; 10(2):160 -166.
  60. Clarkson M.R., Giblin L., Brown A. et al. Reversal of pulmonary hypertension after ligation of a brachiocephalic arteriovenous fistula. Am J Kidney Dis 2002;40: E8
  61. Kawar B., Ellam T., Jackson C. et al. Pulmonary hypertension in renal disease: epidemiology, potential mechanisms and implications. Am J Nephrol 2013; 37(3):281-290.
  62. Malhorta K., Dhawan V., Dalal P. et al. Decompensated high-output congestive heart failure in a patient with AVF and the role of right heart catheterization: a case study. Hemodial Int 2012; 16:58-61.
  63. Najafian J., Taheri Sh., Mahaki B. et al. Comparing right ventricular function and pulmonary artery pressure before and shortly after hemodialysis in patients with end-stage renal disease Adv Biomed Res. 2015; 4:197.
  64. Schier T., Göbel G., Bösmüller C. et al. Incidence of arteriovenous fistula closure due to high output cardiac failure in kidney transplanted patients. Clin transplant 2013; 27:858-865.
  65. Tedford R.J., Forfia P. Hemodynamic evaluation of pulmonary hypertension in chronic kidney disease. Adv Pulmonary Hypertension. 2013; 12(2):82-85.
  66. Yaffe H.C., Greenstein S.M. Should functioning AV fistulas be ligated after renal transplantation? J Vasc Access 2012; 13(4):405-8.
  67. MacRae J.M., Levin A., Belenkie I. The cardiovascular effects of arteriovenous fistulas in chronic kidney disease: a cause for concern? Semin Dial. 2006; 19(5):349-52.
  68. MacRae J.M., Pandeya S., Humen D.P. et al. Arteriovenous fistula-associated high-output cardiac failure: a review of mechanisms. Am J Kidney Dis. 2004; 43:e17-e22.
  69. Raza F., Alkhouli M., Rogers F. Case series of 5 patients with end-stage renal disease with reversible dyspnea, heart failure, and pulmonary hypertension related to arteriovenous dialysis access. Pulm Circ 2015; 5(2):398-406.
  70. Aitken E., Kerr D., Geddes C. et al. Cardiovascular changes occurring with occlusion of a mature arteriovenous fistula. J Vasc Access 2015; 16(6):459 - 466.
  71. Alkhouli M., Sandhu P., Boobes K. et al. Cardiac complications of arteriovenous fistulas in patients with end-stage renal disease. Nefrología 2015; 35:234-45.
  72. O’Leary J.M., Assad T.R., Meng Xu et al. Pulmonary hypertension in patients with chronic kidney disease: invasive hemodynamic etiology and outcomes Pulmonary Circulation 2017; 7(3):674-683.
  73. Voorzaat B.M., van Schaik J., Siebelink H.M. et al. The pros and cons of preserving a functioning arteriovenous fistula after kidney transplantation. J Vasc Access 2016;17 Suppl 1:S16-22.
  74. Clinical Practices Guidelines for Vascular Access. Update 2006. NKF KDOQI 2006.
  75. Brescia M.J., Cimino A.E., Appel K. Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula. N Engl J Med 1966; 27 5:1089-1092.
  76. Branham H.M. Aneurismal varix of the femoral artery and vein following a gunshot wound. Int J Surg 1890; 3:250.
  77. Matas R. On the systemic of cardiovascular effects of arteriovenous fistula. Trans South Surg Assoc 1923; 36:623.
  78. Warren J.V., Nickerson J.L., Elkin D.C. The cardiac output in patients with arteriovenous fistulas. J Clin Invest. 1951; 30(2):210-214.
  79. Ori Y., Korzets A., Katz M. et al. Haemodialysis arteriovenous access- a prospective haemodynamic evaluation. Nephrol Dial Transplant. 1996;11(1):94-7.
  80. Mehta P.A., Dubrey S.W. High output heart failure. Q J Med 2009; 102:235-41.
  81. Amerling R., Ronco C., Kuhlmann M. et al. Arteriovenous fistula toxicity. Blood Purif. 2011; 31:113-120.
  82. Iwashima Y., Horio T., Takami Y. et al. Effects of the creation of arteriovenous fistula for hemodialysis on cardiac function and natriuretic peptide levels in CRF. Am J Kidney Dis. 2002; 40:974-982.
  83. London G.M., Marchais S.J., Guerin A.P. et al. Contributive factors to cardiovascular hypertrophy in renal failure. Am J Hypertens. 1989; 2:261-265.
  84. Unal A., Tasdemir K., Oymak S.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.
  85. Amerling R. Con: On cardiovascular outcomes and the arteriovenous fistula: lesser of evils Nephrol Dial Transplant. 2012; 27:3756-3757.
  86. Basile C., Lomonte C., Vernaglione L. et al. The relationship between the flow of arteriovenous fistula and cardiac output in haemodialysis patients. Nephrol Dial Transplant. 2008; 23(1):282-87.
  87. MacRae J.M., Oliver M., Clark E. et al. Arteriovenous vascular access selection and evaluation Can J Kidney Health Dis 2016; 3:1-13.
  88. Basile C., Lomonte C. Pro: The arteriovenous fistula is a blessing of God. Nephrol Dial Transplant. 2012; 27:3752-3756.
  89. Anand I.S., Florea V.G. High Output Cardiac Failure. Curr Treat Options Cardiovasc Med. 2001; 3(2):151-59.
  90. Reddy Y.N., Melenovsky V., Redfield M.M. et al. High-output heart failure: a 15-year experience. J Am Coll Cardiol. 2016; 68:473-482.
  91. Reddy Y.N., Obokata M., Dean P.G. et al. Long-term cardiovascular changes following creation of arteriovenous fistula in patients with end stage renal disease. Eur Heart J 2017; 38: 1913-1923.
  92. Hickson L.J., Negrotto S.M., Onuigbo M. et al. Echocardiography Criteria for Structural Heart Disease in Patients with End-Stage Renal Disease Initiating Hemodialysis. J Am Coll Cardiol. 2016; 67(10):1173-1182.
  93. Navaneethan S.D., Roy J., Tao K. Prevalence, Predictors, and Outcomes of Pulmonary Hypertension in CKD. J Am Soc Nephrol. 2016; 27(3):877-86.
  94. Selvaraj S., Shah S.J., Ommerborn M.J. et al. Pulmonary hypertension is associated with a higher risk of heart failure hospitalization and mortality in patients with chronic kidney disease: The Jackson Heart Study. Circ Heart Fail 2017; 10(6): e003940.

Другие статьи по теме


Навигация по статьям
Разделы журнала
Наиболее читаемые статьи
Журнал "Нефрология и диализ"