Borba Gabrielle Costa, Andrade Francini Porcher, de Souza Ferreira Tatiane, Pinotti Antônio Fernando Furlan, Veronese Francisco Veríssimo, Rovedder Paula Maria Eidt
Ciências Pneumológicas Post-Graduation Program, Universidade Federal do Rio Grande do Sul (UFRGS), Avenida Ramiro Barcelos, 2400, 2º andar, Porto Alegre, RS, 90040-060, Brazil.
Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.
Int Urol Nephrol. 2023 Apr;55(4):961-968. doi: 10.1007/s11255-022-03381-4. Epub 2022 Sep 29.
To evaluate the estimated pulmonary arterial systolic pressure (PASP) through transthoracic echocardiography in hemodialysis (HD) patients and associate it with cardiorespiratory fitness and pulmonary function.
This study was a cross-sectional analysis of HD patients that performed evaluations of cardiac function, cardiorespiratory fitness, and pulmonary function, through transthoracic echocardiography, cardiopulmonary exercise test, spirometry, and manovacuometry, respectively. All patients underwent the evaluations on a non-dialysis day.
Thirty-five HD patients were evaluated and separated according to the presence of probable pulmonary hypertension (PH) (estimated PASP ≥ 35 mmHg) or not (estimated PASP < 35 mmHg). Those HD patients with probable PH had the worst cardiorespiratory fitness, evaluated by the peak oxygen consumption (VO) (17.11 ± 4.40 versus 12.90 ± 2.73 mL/kg/min; p = 0.011), and pulmonary function, evaluated by absolute and predicted of forced vital capacity (FVC) (85.52 ± 12.29 versus 71.38 ± 11.63%; p = 0.005) and absolute and predicted of forced expiratory volume in the first second (FEV) (83.37 ± 14.98 versus 69.21 ± 13.48%; p = 0.017). The secondary analysis showed that estimated PASP was correlated with VO (r = - 0.508; p = 0.002), FVC (r = - 0.450; p = 0.007), and FEV (r = - 0.361; p = 0.033). Moreover, the adjusted odds ratio by HD vintage, dry weight and gender showed that increments in VO (OR 1.62; CI 95% 1.04-2.54; p = 0.034), FVC (OR 39.67; CI 95% 1.74-902.80; p = 0.021), and FEV (OR 39.54; CI 95% 1.89-826.99; p = 0.018) were associated with 1-fold and 39-fold higher chance, respectively, for not having PH. However, all these associations were lost when age was included in the analysis.
The HD patients with probable PH had the worst cardiorespiratory fitness and pulmonary function. Exploratory analyses showed that greater cardiopulmonary fitness was associated with better cardiac function. Moreover, increments in cardiorespiratory fitness and pulmonary function may increase the chance of not having PH.
通过经胸超声心动图评估血液透析（HD）患者的估计肺动脉收缩压（PASP），并将其与心肺适能和肺功能相关联。
本研究是对HD患者的横断面分析，分别通过经胸超声心动图、心肺运动试验、肺量计和压力容积测定法对心脏功能、心肺适能和肺功能进行评估。所有患者均在非透析日接受评估。
对35例HD患者进行评估，并根据是否存在可能的肺动脉高压（PH）（估计PASP≥35mmHg）进行分组。那些可能患有PH的HD患者，通过峰值耗氧量（VO）评估的心肺适能最差（17.11±4.40对12.90±2.73ml/kg/min；p=0.011），通过用力肺活量（FVC）的绝对值和预测值评估的肺功能最差（85.52±12.29对71.38±11.63%；p=0.005），以及通过第1秒用力呼气量（FEV）的绝对值和预测值评估的肺功能最差（83.37±14.98对69.21± 13.48%；p=0.017）。二次分析显示，估计PASP与VO（r=-0.508；p=0.002）、FVC（r=-0.450；p=0.007）和FEV（r=-0.361；p=0.033）相关。此外，按HD病程、干体重和性别调整后的优势比显示，VO增加（OR 1.62；95%CI 1.04-2.54；p=0.034）、FVC增加（OR 39.67；95%CI 1.74-902.80；p=0.021）和FEV增加（OR 39.54；95%CI 1.89-826.99；p=0.018）分别与患PH的几率降低1倍和39倍相关。然而，当将年龄纳入分析时，所有这些关联均消失。
可能患有PH的HD患者心肺适能和肺功能最差。探索性分析表明，更好的心肺适能与更好的心脏功能相关。此外，心肺适能和肺功能的改善可能会增加不患PH的几率。
