Prävalenz der pulmonalen Hypertonie bei Dialysepatienten mit terminaler Niereninsuffizienz

Zusammenfassung

Hintergrund Bei Patienten mit terminaler Niereninsuffizienz ist die pulmonale Hypertonie (PH) eine häufig beschriebene Komplikation mit unterschiedlicher Ätiologie. Die Prävalenzangaben liegen zwischen 17 – 56 %. Ein Zusammenhang mit einer Volumenüberladung bei Dialysepatienten und der PH wird vermutet.

Methoden Allen Patienten des Dialysezentrums des Universitätsklinikums Gießen wurde ein nichtinvasives Screening auf PH angeboten. Bei Verdacht auf eine PH erfolgte die Korrektur der Flüssigkeitsretention anhand der Bioimpedanzspektroskopie mit dem Ziel der Normovolämie. Bei weiterem V. a. PH im erneuten Screening erfolgte eine invasive Abklärung durch Rechtsherzkatheter.

Ergebnisse 52 Patienten stimmten der Untersuchung zu. Im nichtinvasiven Screening wurde eine PH bei 12 Patienten vermutet (23 %). Nach Einstellung auf Normovolämie bestand noch bei 4 Patienten der V. a. PH (7,7 %), der sich in 2 Fällen im Rechtsherzkatheter bestätigte (3,8 %).

Diskussion Bei Patienten mit terminaler Niereninsuffizienz ist der Verdacht auf PH im nichtinvasiven Screening signifikant mit Überwässerung assoziiert. Nach Korrektur des Flüssigkeitsstatus anhand der Bioimpedanzspektroskopie wurde in unserer Erhebung eine invasiv bestätigte PH in ca. 4 % gefunden.

Abstract

Background In patients with end-stage renal disease (ESRD), pulmonary hypertension (PH) is a frequent complication with different etiologies and a 17 – 56 % prevalence rate. We evaluated the impact of fluid retention measured by bioimpedance on the prevalence of PH in this patient cohort.

Methods All patients with ESRD at the dialysis center of the Medical Clinic II of the University Hospital Gießen were invited to participate in the study and undergo non-invasive PH screening. If the screening suggested PH, patients underwent bioimpedance spectroscopy for measurement of fluid retention followed by adjustment of fluid levels to normovolemia as far as possible. Thereafter a second non-invasive screening was performed in this patient cohort after reaching normovolemia. If signs for PH persisted, patients underwent right heart catheterization for further assessment.

Results 52 patients agreed to participate in the study. After the first noninvasive screening, PH was suspected in 12 patients (23 %). After adjustment of fluid levels to reach normovolemia, PH was suspected only in 4 patients (7.7 %) with confirmation in 2 patients by right heart catheterization (3.8 %).

Discussion In patients with ESRD, PH is frequently associated with fluid retention as shown by bioimpedance spectroscopy. After adjustment of fluid to normal levels, PH was confirmed by invasive test in nearly 4 % of cases.

Publication History

Received: 19 November 2019

Accepted: 13 December 2019

Article published online:
13 February 2020

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