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Physiopathological approach to infective endocarditis in chronic hemodialysis patients: left heart versus right heart

Yassamine Bentata1

  • 1a Department of Nephrology , Medical School, University Mohammed the First , Oujda , Morocco.

Renal Failure
|March 25, 2017
PubMed

Insights

Infectious endocarditis (IE) is common in chronic hemodialysis (CHD) patients, especially on the left heart. The exact cause of right-sided IE in CHD remains unclear, despite central venous catheters potentially playing a role.

Area of Science:

  • Nephrology
  • Infectious Diseases
  • Cardiology

Background:

  • Infectious endocarditis (IE) is a serious cardiac complication for chronic hemodialysis (CHD) patients, with a significantly higher incidence compared to the general population.
  • Left-sided IE is prevalent in CHD patients (80-100%), linked to factors like vascular access manipulation and immune system alterations.
  • Right-sided IE is less common (0-26%) and typically affects the tricuspid valve, with its pathophysiology being less understood.

Purpose of the Study:

  • To explore the potential role of central venous catheters in the development of right-sided IE in CHD patients.
  • To investigate the physiopathological mechanisms underlying right-sided IE in the context of chronic hemodialysis.

Main Methods:

  • This study reviews existing literature and clinical observations regarding IE in CHD patients.
  • Analysis focuses on the differences in IE presentation and potential etiological factors between left-sided and right-sided IE.
  • The role of central venous catheters as a conduit for pathogens to the right heart is specifically examined.

Main Results:

  • Left-sided IE in CHD patients is multifactorial, involving altered valves, immune dysfunction, and bacteremia from vascular access.
  • Right-sided IE, primarily affecting the tricuspid valve, occurs less frequently but its specific pathogenic pathways are not fully elucidated.
  • The direct pathway of germ influx via central venous catheters to the tricuspid valve is hypothesized as a potential contributor to right-sided IE.

Conclusions:

  • While left-sided IE mechanisms are well-established in CHD, the pathophysiology of right-sided IE requires further investigation.
  • Central venous catheter use in CHD patients may facilitate the development of right-sided IE by introducing pathogens directly to the tricuspid valve.
  • Further research is needed to fully understand and address the burden of right-sided IE in the chronic hemodialysis population.

Keywords:
Infective endocarditischronic hemodialysisleft heartphysiopathologyright heart

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