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From combined heart-kidney to kidney transplantation program: what nephrologists should know about dilated
Yannis Lombardi1, Christian Hiesse2,3, Christophe Ridel1
1AURA Paris Plaisance, Paris, France.
Insights
This case study explores heart failure (HF) in a hemodialysis (HD) patient with dilated cardiomyopathy (DCM). Despite optimized treatment, persistent HF symptoms highlight challenges in managing cardiovascular complications in chronic kidney disease patients.
Area of Science:
- Nephrology
- Cardiology
- Internal Medicine
Background:
- A 42-year-old male on home hemodialysis (HD) presented with symptomatic heart failure (HF).
- The patient had a history of kidney transplantation followed by long-term HD.
- He developed acute heart failure symptoms at age 40, diagnosed with severe dilated cardiomyopathy (DCM).
Purpose of the Study:
- To investigate the case of a hemodialysis patient experiencing symptomatic heart failure despite optimized management.
- To explore potential causes and management strategies for dilated cardiomyopathy in patients with end-stage renal disease.
Main Methods:
- Clinical case presentation and review.
- Echocardiography to assess cardiac function and structure.
- Coronarography and myocardial perfusion scintigraphy to rule out ischemic heart disease.
- Laboratory investigations including complete blood count, cardiac biomarkers (troponin, BNP), inflammatory markers (CRP), and nutritional/thyroid parameters.
Main Results:
- Echocardiography confirmed severe dilated cardiomyopathy (DCM).
- Coronary angiography and myocardial perfusion scintigraphy revealed no significant abnormalities.
- Despite optimized beta-blocker and RAAS inhibitor therapy, the patient's dyspnea persisted.
- Elevated B-type natriuretic peptide (BNP) levels (1527 ng/ml) indicated significant heart failure.
- Anemia (Hemoglobin 9.8 g/dl) was noted, but other metabolic and inflammatory markers were within normal limits.
Conclusions:
- Symptomatic heart failure and dilated cardiomyopathy can occur in hemodialysis patients even with optimized medical therapy.
- Cardiovascular complications, particularly DCM, require careful consideration and management in patients with end-stage renal disease.
- Further investigation into non-ischemic etiologies and advanced therapeutic options may be warranted for refractory heart failure in this population.
Abstract:
A 42-year-old hemodialysis (HD) patient was investigated in our department for symptomatic heart failure (HF) despite daily home dialysis. He had a history of living donor kidney transplantation at the age of 18 that lasted 7 years. Home dialysis was then started. At the age of 40, he developed acute heart failure symptoms. Echocardiography revealed severe dilated cardiomyopathy (DCM). Coronarography and myocardial perfusion scintigraphy showed no abnormal findings. Betablockers were administrated, and RAAS inhibitor dosing was optimized. Dyspnea persisted, and patient was referred to our department. At admission, blood pressure was 116/82 mmHg, and pulse 68 beats/min. No peripheral edema was observed. Dry weight was 62.5 kg. Patient was anuric. Hemoglobin level was 9.8 g/dl, highly sensitive troponin level was 62 ng/ml, and BNP level was 1527 ng/ml. The liver enzyme levels were normal. C-reactive protein was 4.2 mg/ml. Vitamin level, zinc levels, and thyroid function were normal.
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