Department of Endocrinology and Nephrology, North Zealand University Hospital, Dyrehavevej 29, 3400, Hilleroed, Denmark.
Department of Cardiology, Rigshospitalet University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.
BMC Nephrol. 2020 Jul 11;21(1):266. doi: 10.1186/s12882-020-01924-4.
Setting the dry weight and maintaining fluid balance is still a difficult challenge in dialysis patients. Overhydration is common and associated with increased cardiac morbidity and mortality. Pulmonary hypertension is associated with volume overload in end-stage renal dysfunction patients. Thus, monitoring pulmonary pressure by a CardioMEMS device could potentially be of guidance to physicians in the difficult task of assessing fluid overload in hemodialysis patients.
61-year old male with known congestive heart failure deteriorated over 3 months' time from a state with congestive heart failure and diuresis to a state of chronic kidney disease and anuria. He began a thrice/week in-hospital hemodialysis regime. As he already had implanted a CardioMEMS device due to his heart condition, we were able to monitor invasive pulmonary artery pressure during the course of dialysis sessions. To compare, we estimated overhydration by both bioimpedance and clinical assessment. Pulmonary artery pressure correlated closely with fluid drainage during dialysis and inter-dialytic weight gain. The patient reached prescribed dry weight but remained pulmonary hypertensive by definition. During two episodes of intradialytic systemic hypotension, the patient still had pulmonary hypertension by current definition.
This case report observes a close correlation between pulmonary artery pressure and fluid overload in a limited amount of observations. In this case we found pulmonary artery pressure to be more sensitive towards fluid overload than bioimpedance. The patient remained pulmonary hypertensive both as he reached prescribed dry weight and experienced intradialytic hypotensive symptoms. Monitoring pulmonary artery pressure via CardioMEMS could hold great potential as a real-time guidance for fluid balance during hemodialysis, though adjusted cut-off values for pulmonary pressure for anuric patients may be needed. Further studies are needed to confirm the findings of this case report and the applicability of pulmonary pressure in assessing optimal fluid balance.
设定干体重并维持液体平衡仍然是透析患者面临的一项艰巨挑战。透析患者普遍存在水负荷过多的问题，这与增加心脏发病率和死亡率有关。肺动脉高压与终末期肾功能障碍患者的容量超负荷有关。因此，通过 CardioMEMS 设备监测肺压，有可能为医生评估血液透析患者的液体超负荷提供指导。
一名 61 岁男性，患有充血性心力衰竭，在 3 个月的时间内从充血性心力衰竭和利尿状态恶化至慢性肾脏病和无尿状态。他开始每周接受三次住院血液透析治疗。由于他的心脏状况已经植入了 CardioMEMS 设备，因此我们能够在透析过程中监测有创肺动脉压。为了进行比较，我们通过生物阻抗和临床评估来估计水负荷过多。肺动脉压与透析过程中的液体引流和透析间体重增加密切相关。该患者达到了规定的干体重，但仍符合肺动脉高压的定义。在两次透析期间发生的全身低血压事件中，根据当前的定义，患者仍存在肺动脉高压。
本病例报告观察到在有限的观察中，肺动脉压与液体超负荷之间存在密切相关性。在本病例中，我们发现肺动脉压比生物阻抗更能敏感地反映液体超负荷。该患者在达到规定的干体重并经历透析期间低血压症状时，仍存在肺动脉高压。通过 CardioMEMS 监测肺动脉压可能具有很大的潜力，可作为血液透析期间液体平衡的实时指导，但可能需要为无尿患者调整肺动脉压的临界值。需要进一步的研究来证实本病例报告的发现以及肺动脉压在评估最佳液体平衡方面的适用性。
