The problem of pulmonary arterial hypertension in end-stage renal disease: can peritoneal dialysis be the solution.

BACKGROUND: Pulmonary arterial hypertension (PAH) in the setting of end-stage renal disease (ESRD) has important prognostic and therapeutic consequences. We estimated the prevalence of PAH among patients with ESRD treated with automated peritoneal dialysis (APD), investigated the effect of different variables and compared pulmonary artery pressure and cardiac function at the beginning and end of the study. METHODS: This is a 5-year study in which 31 ESRD patients on APD were recruited after fulfilling inclusion criteria. Blood samples were collected from all patients for the biochemical and hematological data at the beginning of the study and every month and at the study termination. Total body water (TBW) and extracellular water (ECW) were calculated using Watson's and Bird's calculation methods. All patients were followed-up at 3-month interval for cardiac evaluation. Logistic regression analysis was used to assess the relation between different variables and PAH. RESULTS: The mean age of the study population (n = 31) was 51.23 ± 15.24 years. PAH was found in 24.2% of the patients. Mean systolic pulmonary artery pressure (sPAP) and mean pulmonary artery pressure (mPAP) were significantly higher in the APD patients at study initiation than at the end of the study (40.75 + 10.61 vs 23.55 + 9.20 and 29.66 + 11.35 vs 18.24 + 6.75 mmHg respectively, p = 0.001). The median ejection fraction was significantly lower in patients with PAH at zero point than at study termination [31% (27-34) vs 50% (46-52), p = 0.002]. Hypervolemia decreased significantly at the end of study (p <  0.001) and correlated positively with the PAP (r = 0.371 and r = 0.369), p = 0.002). sPAP correlated with left ventricular mass index, hemoglobin level, and duration on APD. CONCLUSIONS: Long term APD (> 1 years) seemed to decrease pulmonary arterial pressure, right atrial pressure and improve left ventricular ejection fraction (LVEF). Risk factors for PAH in ESRD were hypervolemia, abnormal ECHO findings and low hemoglobin levels. Clinical and echocardiographic abnormalities and complications are not uncommon among ESRD patients with PAH. Identification of those patients on transthoracic echocardiography may warrant further attention to treatment with APD.

Iatrogenic Hypothermia during Hemodialysis Can Induce Serious Cardiac Arrhythmias in Diabetic Patient.

Cardiovascular diseases are the main cause of morbidity and mortality in end-stage renal disease (ESRD) patients. Cardiac arrhythmias are prevalent in patients undergoing hemodialysis (HD), however, dialysis treatment per se can be considered as an arrhythmogenic stimulus. Uremic patients are characterized by a "pro-arrhythmic substrate" because of the high prevalence of ischemic heart disease, left ventricular hypertrophy, and autonomic neuropathy. The incidence of hypothermia in HD patient is unknown. The severity of hypothermia correlated to cardiac arrhythmias. Here, we report a 50-year-old Saudi lady known case of long-standing diabetes mellitus with diabetic retinopathy, nephropathy and neuropathy, ESRD on HD, coronary artery disease developed transient third-degree heart block secondary to iatrogenic hypothermia during HD session, which was completely resolved after adjusting temperature of dialysis machine. To the best of our knowledge, the association of third-degree atrioventricular block and hypothermia induced by HD session has not been previously reported.

Recurrent syndrome of inappropriate antidiuretic hormone secretion due to tolterodine in an elderly male patient.

Hyponatremia is defined as serum sodium of <135 mmol/L and equates with a low serum osmolality once translocational hyponatremia and pseudohyponatremia are ruled out. True hyponatremia develops when normal urine-diluting mechanisms are disturbed. In elderly patients, this complication is not uncommon, especially in nursing homes and assisted living facilities. Medications are often the most common cause of hyponatremia in these patients. Herewith, we reported a 65-year-old Saudi male, a known case of benign prostatic hypertrophy and hypertension, who developed recurrent hyponatremia secondary to tolterodine. To our knowledge, this is the fifth case reported in literature of such association.