Investigation into cardiac sympathetic innervation during the commencement of haemodialysis in patients with chronic kidney disease

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Abstract

Background

Patients with chronic kidney disease (CKD) who undergo chronic haemodialysis (HD) show altered sympathetic tone, which is related to a higher cardiovascular mortality. The purpose of this study was to investigate the effect of transition from pre-HD to HD on cardiac sympathetic innervation.

Methods

Eighteen patients aged 58 ± 18 years (mean ± standard deviation [SD]), 13 males and five females, with stage 5 CKD and nine healthy control subjects aged 52 ± 17 (mean ± SD), three males and six females, were included in this prospective study between May 2010 and December 2013. All patients underwent ¹²³I-labelled meta-iodobenzylguanidine ( ¹²³I-MIBG) scintigraphy for cardiac sympathetic innervation and electrocardiographically gated adenosine stress and rest ^99mTc-labelled tetrofosmin single-photon emission computed tomography for myocardial perfusion imaging prior to (pre-HD) and 6 months after the start of HD. Results of ¹²³I-MIBG scans in patients were compared to controls. Impaired cardiac sympathetic innervation was defined as late heart-to-mediastinum ratio (HMR) < 2.0.

Results

Mean late HMR was lower in patients during HD (2.3) than in controls (2.9) ( p = 0.035); however, in patients it did not differ between pre-HD and after the start of HD. During HD, two patients showed new sympathetic innervation abnormalities, and in three patients innervation abnormalities seemed to coincide with myocardial perfusion abnormalities.

Conclusions

CKD patients show cardiac sympathetic innervation abnormalities, which do not seem to progress during the maintenance HD. The relationship between sympathetic innervation abnormalities and myocardial perfusion abnormalities in HD patients needs further exploration.

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Most cited references 15

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Chronic kidney disease and mortality risk: a systematic review.

Marcello Tonelli, Natasha Wiebe, Bruce Culleton … (2006)

Current guidelines identify people with chronic kidney disease (CKD) as being at high risk for cardiovascular and all-cause mortality. Because as many as 19 million Americans may have CKD, a comprehensive summary of this risk would be potentially useful for planning public health policy. A systematic review of the association between non-dialysis-dependent CKD and the risk for all-cause and cardiovascular mortality was conducted. Patient- and study-related characteristics that influenced the magnitude of these associations also were investigated. MEDLINE and EMBASE databases were searched, and reference lists through December 2004 were consulted. Authors of 10 primary studies provided additional data. Cohort studies or cohort analyses of randomized, controlled trials that compared mortality between those with and without chronically reduced kidney function were included. Studies were excluded from review when participants were followed for < 1 yr or had ESRD. Two reviewers independently extracted data on study setting, quality, participant and renal function characteristics, and outcomes. Thirty-nine studies that followed a total of 1,371,990 participants were reviewed. The unadjusted relative risk for mortality in participants with reduced kidney function compared with those without ranged from 0.94 to 5.0 and was significantly more than 1.0 in 93% of cohorts. Among the 16 studies that provided suitable data, the absolute risk for death increased exponentially with decreasing renal function. Fourteen cohorts described the risk for mortality from reduced kidney function, after adjustment for other established risk factors. Although adjusted relative hazards were consistently lower than unadjusted relative risks (median reduction 17%), they remained significantly more than 1.0 in 71% of cohorts. This review supports current guidelines that identify individuals with CKD as being at high risk for cardiovascular mortality. Determining which interventions best offset this risk remains a health priority.

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Proposal for standardization of 123I-metaiodobenzylguanidine (MIBG) cardiac sympathetic imaging by the EANM Cardiovascular Committee and the European Council of Nuclear Cardiology.

Ignasi Carrió, , … (2010)

This proposal for standardization of (123)I-metaiodobenzylguanidine (iobenguane, MIBG) cardiac sympathetic imaging includes recommendations for patient information and preparation, radiopharmaceutical, injected activities and dosimetry, image acquisition, quality control, reconstruction methods, attenuation, scatter and collimator response compensation, data analysis and interpretation, reports, and image display. The recommendations are based on evidence coming from original or scientific studies whenever possible and as far as possible reflect the current state-of-the-art in cardiac MIBG imaging. The recommendations are designed to assist in the practice of performing, interpreting and reporting cardiac sympathetic imaging. The proposed standardization does not include clinical indications, benefits or drawbacks of cardiac sympathetic imaging, and does not address cost benefits or cost effectiveness; however, clinical settings of potential utility are mentioned. Standardization of MIBG cardiac sympathetic imaging should contribute to increasing its clinical applicability and integration into current nuclear cardiology practice.

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Vlado Perkovic (2012)

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Author and article information

Contributors

Walter Noordzij:

ORCID: http://orcid.org/0000-0001-6386-5499

0031 50 361 61 61 , w.noordzij@umcg.nl

Journal

Journal ID (nlm-ta): Eur Radiol Exp

Journal ID (iso-abbrev): Eur Radiol Exp

Title: European Radiology Experimental

Publisher: Springer International Publishing (Cham )

ISSN (Electronic): 2509-9280

Publication date (Electronic): 6 December 2017

Publication date PMC-release: 6 December 2017

Publication date (Print): 2017

Volume: 1

Issue: 1

Electronic Location Identifier: 24

Affiliations

[1 ]Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

[2 ]Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands

[3 ]Dialysis Center Groningen, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands

[4 ]Department of Cardiology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands

Author information

Walter Noordzij http://orcid.org/0000-0001-6386-5499

Article

Publisher ID: 27

DOI: 10.1186/s41747-017-0027-0

PMC ID: 5909356

SO-VID: b0db520b-3e2b-4af7-aba2-b24e396b4bf8

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

History

Date received : 8 August 2017

Date accepted : 20 October 2017

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100006775, GE Healthcare;

Custom metadata

Keywords: chronic kidney disease,haemodialysis,myocardial ischaemia,myocardial scintigraphy,sympathetic innervation

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Keywords: chronic kidney disease, haemodialysis, myocardial ischaemia, myocardial scintigraphy, sympathetic innervation

Investigation into cardiac sympathetic innervation during the commencement of haemodialysis in patients with chronic kidney disease

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Most cited references 15

Chronic kidney disease and mortality risk: a systematic review.

Proposal for standardization of 123I-metaiodobenzylguanidine (MIBG) cardiac sympathetic imaging by the EANM Cardiovascular Committee and the European Council of Nuclear Cardiology.

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