The relationship between heart functions and anemia in patients with end-stage renal disease receiving hemodialysis

Year 2024, Volume: 10 Issue: 1 - January 2024, 118 - 126, 04.01.2024

Timor Omar , Metin Çağdaş , İnanç Artaç , Muammer Karakayalı , Doğan İliş , Ayça Arslan , Yavuz Karabağ , Mahmut Yesin , Mustafa Avcı , İbrahim Rencüzoğulları

https://doi.org/10.18621/eurj.1401607

Cited By: 1

Abstract

Objective: We investigated the relationship between anemia and cardiac functions by conventional and speckle-tracking echocardiography (STE) in patients with end-stage renal disease (ESRD) receiving hemodialysis.

Methods: One hundred six patients with ESRD receiving hemodialysis were included in this cross-sectional study. The conventional echocardiography and STE findings were compared between the patients with and without anemia. In addition, a comparison of the findings between the ESRD patients and healthy controls consisting of 68 participants was conducted.

Results: Compared to healthy controls, ESRD patients had lower left ventricular ejection fraction (LVEF), left ventricular global longitudinal strain (LVGLS), and left atrial reservoir strain (LASr) [53% (48-57) vs. 65% (62-68), -15.2 (-16.9˗ -13.6) vs. -19.7 (-16.9˗ -13.6), and -21.9 (-29.5˗ -15.3) vs. -29.9 (-35.3˗ -22.8), respectively, P-value <0.001 for all]. Of the ESRD patients, 70 (66%) had anemia. ESRD patients with anemia had higher interventricular septum (IVS), posterior wall (PW), and left atrial volume index (LAVi) values than patients without anemia. In addition, ESRD patients with anemia had lower LVEF, LVGLS, and LASr than patients without anemia [median (IQR), 13 (12-15) vs. 12 (11-14), P=0.004, 13 (12-15) vs. 12 (11-13.5), P<0.005, 43 (35-55) vs. 34.7 (28-50), P=0.013, 52 (48-55) vs. 56 (47.5-60), P=0.016, -14.6 (-16.4˗ -13.5) vs. -16 (-18.6˗ -14.7), P=0.003, and -21.6 (-30.5˗ -16.3) vs. -30.5 (-33.6˗ -23.3), P=0.006, respectively]. In multivariable logistic regression analysis, diabetes, PW, LASr, and LVGLS were independently associated with the presence of anemia in ESRD patients.

Conclusion: Our study confirmed impaired cardiac mechanics in ESRD hemodialysis patients and showed that anemia was associated with further worsening cardiac mechanics in this population.

Keywords

Echocardiography, end-stage renal disease, hemodialysis, anemia

References

• 1. Thurlow JS, Joshi M, Yan G, et al. Global epidemiology of end-stage kidney disease and disparities in kidney replacement therapy. Am J Nephrol. 2021;52(2):98-107. doi: 10.1159/000514550.
• 2. Levey AS, Beto JA, Coronado BE, et al. Controlling the epidemic of cardiovascular disease in chronic renal disease: what do we know? What do we need to learn? Where do we go from here? National Kidney Foundation Task Force on Cardiovascular Disease. Am J Kidney Dis. 1998;32(5):853-906. doi: 10.1016/s0272-6386(98)70145-3.
• 3. Foley RN, Parfrey PS, Sarnak MJ. Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis. 1998;32(5 Suppl 3):S112-9. doi: 10.1053/ajkd.1998.v32.pm9820470.
• 4. Jankowski J, Floege J, Fliser D, Böhm M, Marx N. Cardiovascular disease in chronic kidney disease: pathophysiological insights and therapeutic options. Circulation. 2021;143(11):1157-1172. doi: 10.1161/CIRCULATIONAHA.120.050686.
• 5. Georgatzakou HT, Antonelou MH, Papassideri IS, Kriebardis AG. Red blood cell abnormalities and the pathogenesis of anemia in end-stage renal disease. Proteomics Clin Appl. 2016;10(8):778-790. doi: 10.1002/prca.201500127.
• 6. Sofue T, Nakagawa N, Kanda E, et al. Prevalence of anemia in patients with chronic kidney disease in Japan: a nationwide, cross-sectional cohort study using data from the Japan Chronic Kidney Disease Database (J-CKD-DB). PLoS One. 2020;15(7):e0236132. doi: 10.1371/journal.pone.0236132.
• 7. Omrani H, Golshani S, Sharifi V, Almasi A, Sadeghi M. The relationship between hemodialysis and the echocardiographic findings in patients with chronic kidney disease. Med Arch. 2016;70(5):328-331. doi: 10.5455/medarh.2016.70.328-331.
• 8. Parfrey PS, Harnett JD, Barre PE. The natural history of myocardial disease in dialysis patients. J Am Soc Nephrol. 1991;2(1):2-12. doi: 10.1681/ASN.V212.
• 9. Li S, Foley RN, Collins AJ. Anemia and cardiovascular disease, hospitalization, end stage renal disease, and death in older patients with chronic kidney disease. Int Urol Nephrol. 2005;37(2):395-402. doi: 10.1007/s11255-004-3068-2.
• 10. Eknoyan G, Lameire N, Eckardt K, et al. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl. 2013;3(1):5-14. doi: 10.1038/kisup.2012.76.
• 11. McMurray JJV, Parfrey PS, Adamson JW, et al. Kidney disease: Improving global outcomes (KDIGO) anemia work group. KDIGO clinical practice guideline for anemia in chronic kidney disease. Kidney Int Suppl. 2012;2(4):279-335. doi: 10.1038/kisup.2012.37.
• 12. Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of, Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2016;17(4):412. doi: 10.1093/ehjci/jew041.
• 13. Voigt JU, Pedrizzetti G, Lysyansky P, et al. Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. J Am Soc Echocardiogr. 2015;28(2):183-193. doi: 10.1016/j.echo.2014.11.003.
• 14. Foley RN, Parfrey PS, Harnett JD, et al. Clinical and echocardiographic disease in patients starting end-stage renal disease therapy. Kidney Int. 1995;47(1):186-192. doi: 10.1038/ki.1995.22.
• 15. Hickson LJ, Negrotto SM, 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. doi: 10.1016/j.jacc.2015.12.052.
• 16. Sikole A, Polenakovic M, Spirovska V, Polenakovic B, Masin G. Analysis of heart morphology and function following erythropoietin treatment of anemic dialysis patients. Artif Organs. 1993;17(12):977-984. doi: 10.1111/j.1525-1594.1993.tb03179.x.
• 17. Levin A, Thompson CR, Ethier J, et al. Left ventricular mass index increase in early renal disease: impact of decline in hemoglobin. Am J Kidney Dis. 1999;34(1):125-134. doi: 10.1016/s0272-6386(99)70118-6.
• 18. Bansal N, Keane M, Delafontaine P, et al; CRIC Study Investigators. A longitudinal study of left ventricular function and structure from CKD to ESRD: the CRIC study. Clin J Am Soc Nephrol. 2013;8(3):355-362. doi: 10.2215/CJN.06020612.
• 19. Gulel O, Soylu K, Yuksel S, et al. Evidence of left ventricular systolic and diastolic dysfunction by color tissue Doppler imaging despite normal ejection fraction in patients on chronic hemodialysis program. Echocardiography. 2008;25(6):569-574. doi: 10.1111/j.1540-8175.2008.00657.x.
• 20. De Lima JJG, Macedo TA, Gowdak LHW, David-Neto E, Bortolotto LA. Diastolic and systolic left ventricular dysfunction and mortality in chronic kidney disease patients on haemodialysis. Nephrology (Carlton). 2022;27(1):66-73. doi: 10.1111/nep.13960.
• 21. Schärer K, Schmidt KG, Soergel M. Cardiac function and structure in patients with chronic renal failure. Pediatr Nephrol. 1999;13(9):951-965. doi: 10.1007/s004670050737.
• 22. Liu YW, Su CT, Huang YY, et al. Left ventricular systolic strain in chronic kidney disease and hemodialysis patients. Am J Nephrol. 2011;33(1):84-90. doi: 10.1159/000322709.
• 23. Chen R, Wu X, Shen LJ, et al Left ventricular myocardial function in hemodialysis and nondialysis uremia patients: a three-dimensional speckle-tracking echocardiography study. PLoS One. 2014;9(6):e100265. doi: 10.1371/journal.pone.0100265.
• 24. Cameli M, Mandoli GE, Sciaccaluga C, Mondillo S. More than 10years of speckle tracking echocardiography: Still a novel technique or a definite tool for clinical practice? Echocardiography. 2019;36(5):958-970. doi: 10.1111/echo.14339.
• 25. Bhagat N, Dawman L, Naganur S, et al. Impact of anemia on the cardiovascular status in children with chronic kidney disease: a pilot study. Clin Nutr ESPEN. 2022;47:283-287. doi: 10.1016/j.clnesp.2021.11.031.
• 26. Sulemane S, Panoulas VF, Nihoyannopoulos P. Echocardiographic assessment in patients with chronic kidney disease: current update. Echocardiography. 2017;34(4):594-602. doi: 10.1111/echo.13495.
• 27. Demirtas L, Turkmen K, Buyuklu M, Kocyigit I, Orscelik O. Atrial electromechanical delay and left atrial mechanical functions in hemodialysis and peritoneal dialysis patients. Int Urol Nephrol. 2016;48(5):781-789. doi: 10.1007/s11255-016-1238-7.
• 28. Calleja AM, Rakowski H, Williams LK, Jamorski M, Chan CT, Carasso S. Left atrial and ventricular systolic and diastolic myocardial mechanics in patients with end-stage renal disease. Echocardiography. 2016;33(10):1495-1503. doi: 10.1111/echo.13284.