Pulmonary Hypertension versus pulmonary congestion in Haemodialysis patients in relation to increased Interdialytic weight gain

Abstract

Volume overload is considered as an important clinical problem in end stage renal disease patients. It is associated with morbid situations such as pulmonary hypertension and lung congestion. Aim of the Work: to assess the effect of increased the patient weight between haemodialysis sessions that is known as interdialytic weight gain (IDWG) on pulmonary hypertension using Echocardiography (Echo) and lung congestion using lung ultrasound (LUS) in two groups: First group with IDWG < 3.5% of their dry weight while Second group with IDWG > 3.5 % of their dry weight, compare between the two groups and to detect statistically the effects of IDWG & ultrafiltration on PAP and lung congestion. Patients and Methods: This observational cross sectional study was conducted at on 60 patients who have end stage kidney disease &are currently on haemodialysis at Nasser Institute Hospital: 30 patients with an IDWG < 3.5% and 30 patients with an IDWG > 3.5% of their dry weight. Pulmonary artery pressure was measured by echo and patients classified according to PAP into mild, moderate and severe pulmonary hypertension. Lung congestion in all patients was measured by lung ultrasound and patients classified into minimal, mild, moderate and severe lung congestion. Results: Our study showed that pulmonary hypertension prevalence was 30% while lung congestion was 100%. pulmonary hypertension pathophysiology includes acute and chronic processes and HD therapy alone is not effective in complete treatment of pulmonary hypertension and require medical treatment. Patients with increased IDWG > 3.5% (group 2) had pre HD higher PAP than those with IDWG < 3.5% (group 1) and patients with IDWG > 3.5% had more change in their PAP post HD session than those with IDWG < 3.5% but no significant difference between the change after the HD session in both groups. HD duration is an important factor in PH development over years. There is a significant relation anemia and hypercalcemia with PH. Patients with more increased IDWG > 3.5 % (group 2) had higher pulmonary congestion than those with IDWG < 3.5% (group 1) and patients with IDWG < 3.5% had more change in their lung congestion level after the HD session than those with IDWG > 3.5% but no statistical significance between the change in both groups. There was a significant relation between HD therapy duration with pulmonary congestion measured prior to the session. Conclusion: on the short term increased IDWG% affect lung congestion more than pulmonary hypertension.