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Erschienen in: Wiener klinische Wochenschrift 3-4/2021

28.11.2019 | original article

Impact of hemodialysis on liver stiffness measured with real-time two-dimensional shear wave elastography

verfasst von: Danijela Zjacic Puljiz, Antonio Mestrovic, Ivan Zaja, Ante Tonkic, MD, PhD, Ivica Grgurevic, Darko Duplancic, Ivana Kristina Delic Jukic, Dragan Ljutic, Zeljko Puljiz

Erschienen in: Wiener klinische Wochenschrift | Ausgabe 3-4/2021

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Summary

Background and aims

The impact of hemodialysis on liver stiffness is still unclear. The aim of the study was to assess liver fibrosis by real-time two-dimensional shear wave elastography (RT 2D-SWE) and to quantify the influence of net fluid withdrawal on liver stiffness during one hemodialysis session. The second aim was to investigate the influence of systolic blood pressure and time spent on dialysis (in years) on liver stiffness measurements.

Methods

This before/after hemodialysis (HD) study in a group of end stage renal disease (ESRD) patients was carried out with patients on regular HD. Measurements of liver stiffness were done using RT 2D-SWE directly before and after a hemodialysis session.

Results

In this study 27 patients with mean age 69.4 ± 14.75 years were included. Mean net fluid withdrawal volume per session was 2874.07 ± 778.35 ml. Mean pre-HD and post-HD liver stiffness measurements were 8.15 kPa (95% confidence interval, CI 7.61–8.68) and 6.70 kPa (95% CI 6.10–7.30 kPa), respectively. Mean liver stiffness reduction was 1.448 ± 1.14 kPa. The amount of fluid removed correlated with the decline in liver stiffness values after HD (ρ = 0.523, P = 0.003). There was a positive but statistically not significant correlation between time spent in HD and liver stiffness (ρ = 0.151, P = 0.623)

Conclusion

Liver stiffness significantly declined after one session of HD. The change in liver stiffness was strongly correlated with the amount of net fluid withdrawal. Random liver stiffness measurements (LSM) by RT 2D-SWE does not precisely show the degree of fibrosis, Furthermore, it is presumed that postdialysis liver stiffness values likely reflect the real degree of liver fibrosis.
Literatur
1.
Zurück zum Zitat Schoolwerth AC, Engelgau MM, Hostetter TH, Rufo KH, Chianchiano D, McClellan WM, et al. Chronic kidney disease: a public health problem that needs a public health action plan. Prev Chronic Dis. 2006;3(2):A57.PubMedPubMedCentral Schoolwerth AC, Engelgau MM, Hostetter TH, Rufo KH, Chianchiano D, McClellan WM, et al. Chronic kidney disease: a public health problem that needs a public health action plan. Prev Chronic Dis. 2006;3(2):A57.PubMedPubMedCentral
2.
Zurück zum Zitat Collins AJ, Foley RN, Chavers B, Gilbertson D, Herzog C, Ishani A, et al. US renal data system 2013 annual data report. Am J Kidney Dis. 2014;63(1):A7.CrossRef Collins AJ, Foley RN, Chavers B, Gilbertson D, Herzog C, Ishani A, et al. US renal data system 2013 annual data report. Am J Kidney Dis. 2014;63(1):A7.CrossRef
3.
Zurück zum Zitat Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351(13):1296–305.CrossRef Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351(13):1296–305.CrossRef
4.
Zurück zum Zitat Fabrizi F, Poordad FF, Martin P. Hepatitis C infection and the patient with end-stage renal disease. Hepatology. 2002;36(1):3–10.CrossRef Fabrizi F, Poordad FF, Martin P. Hepatitis C infection and the patient with end-stage renal disease. Hepatology. 2002;36(1):3–10.CrossRef
5.
Zurück zum Zitat Martin P, Fabrizi F. Hepatitis C virus and kidney disease. J Hepatol. 2008;49(4):613–24.CrossRef Martin P, Fabrizi F. Hepatitis C virus and kidney disease. J Hepatol. 2008;49(4):613–24.CrossRef
6.
Zurück zum Zitat Bravo AA, Sheth SG, Chopra S. Liver biopsy. N Engl J Med. 2001;344(7):495–500.CrossRef Bravo AA, Sheth SG, Chopra S. Liver biopsy. N Engl J Med. 2001;344(7):495–500.CrossRef
7.
Zurück zum Zitat Ozdogan M, Ozgur O, Boyacioglu S, Coskun M, Kart H, Ozdal S, et al. Percutaneous liver biopsy complications in patients with chronic renal failure. Nephron. 1996;74(2):442–3.CrossRef Ozdogan M, Ozgur O, Boyacioglu S, Coskun M, Kart H, Ozdal S, et al. Percutaneous liver biopsy complications in patients with chronic renal failure. Nephron. 1996;74(2):442–3.CrossRef
8.
Zurück zum Zitat Rockey DC, Caldwell SH, Goodman ZD, Nelson RC, Smith AD, American Association for the Study of Liver Diseases. Liver biopsy. Hepatology. 2009;49(3):1017–44.CrossRef Rockey DC, Caldwell SH, Goodman ZD, Nelson RC, Smith AD, American Association for the Study of Liver Diseases. Liver biopsy. Hepatology. 2009;49(3):1017–44.CrossRef
9.
Zurück zum Zitat European Association for Study of Liver, Asociacion Latinoamericana para el Estudio del Higado. EASL-ALEH clinical practice guidelines: non-invasive tests for evaluation of liver disease severity and prognosis. J Hepatol. 2015;63(1):237–64.CrossRef European Association for Study of Liver, Asociacion Latinoamericana para el Estudio del Higado. EASL-ALEH clinical practice guidelines: non-invasive tests for evaluation of liver disease severity and prognosis. J Hepatol. 2015;63(1):237–64.CrossRef
10.
Zurück zum Zitat Bende F, Mulabecirovic A, Sporea I, Popescu A, Sirli R, Gilja OH, et al. Assessing liver stiffness by 2‑D shear wave elastography in a healthy cohort. Ultrasound Med Biol. 2018;44(2):332–41.CrossRef Bende F, Mulabecirovic A, Sporea I, Popescu A, Sirli R, Gilja OH, et al. Assessing liver stiffness by 2‑D shear wave elastography in a healthy cohort. Ultrasound Med Biol. 2018;44(2):332–41.CrossRef
11.
Zurück zum Zitat Bende F, Sporea I, Sirli R, Popescu A, Mare R, Miutescu B, et al. Performance of 2D-SWE.GE for predicting different stages of liver fibrosis, using transient elastography as the reference method. Med Ultrason. 2017;19(2):143–9.CrossRef Bende F, Sporea I, Sirli R, Popescu A, Mare R, Miutescu B, et al. Performance of 2D-SWE.GE for predicting different stages of liver fibrosis, using transient elastography as the reference method. Med Ultrason. 2017;19(2):143–9.CrossRef
12.
Zurück zum Zitat Grgurevic I, Puljiz Z, Brnic D, Bokun T, Heinzl R, Lukic A, et al. Liver and spleen stiffness and their ratio assessed by real-time two dimensional-shear wave elastography in patients with liver fibrosis and cirrhosis due to chronic viral hepatitis. Eur Radiol. 2015;25(11):3214–21.CrossRef Grgurevic I, Puljiz Z, Brnic D, Bokun T, Heinzl R, Lukic A, et al. Liver and spleen stiffness and their ratio assessed by real-time two dimensional-shear wave elastography in patients with liver fibrosis and cirrhosis due to chronic viral hepatitis. Eur Radiol. 2015;25(11):3214–21.CrossRef
13.
Zurück zum Zitat Dietrich CF, Bamber J, Berzigotti A, Bota S, Cantisani V, Castera L, et al. EFSUMB guidelines and recommendations on the clinical use of liver ultrasound elastography, update 2017 (long version). Ultraschall Med. 2017;38(4):e16–e47.CrossRef Dietrich CF, Bamber J, Berzigotti A, Bota S, Cantisani V, Castera L, et al. EFSUMB guidelines and recommendations on the clinical use of liver ultrasound elastography, update 2017 (long version). Ultraschall Med. 2017;38(4):e16–e47.CrossRef
14.
Zurück zum Zitat Sigrist RMS, Liau J, Kaffas AE, Chammas MC, Willmann JK. Ultrasound elastography: review of techniques and clinical applications. Theranostics. 2017;7(5):1303–29.CrossRef Sigrist RMS, Liau J, Kaffas AE, Chammas MC, Willmann JK. Ultrasound elastography: review of techniques and clinical applications. Theranostics. 2017;7(5):1303–29.CrossRef
15.
Zurück zum Zitat Hermann E, de Ledinghen V, Cassinotto C, Chu WC, Leung VY, Ferraioli G, et al. Assessment of biopsy-proven liver fibrosis by two-dimensional shear wave elastography: an individual patient data-based meta-analysis. Hepatology. 2018;67(1):260–72.CrossRef Hermann E, de Ledinghen V, Cassinotto C, Chu WC, Leung VY, Ferraioli G, et al. Assessment of biopsy-proven liver fibrosis by two-dimensional shear wave elastography: an individual patient data-based meta-analysis. Hepatology. 2018;67(1):260–72.CrossRef
16.
Zurück zum Zitat Paul SB, Das P, Mahanta M, Sreenivas V, Kedia S, Kalra N, et al. Assessment of liver fibrosis in chronic hepatitis: comparison of shear wave elastography and transient elastography. Abdom Radiol (NY). 2017;42(12):2864–73.CrossRef Paul SB, Das P, Mahanta M, Sreenivas V, Kedia S, Kalra N, et al. Assessment of liver fibrosis in chronic hepatitis: comparison of shear wave elastography and transient elastography. Abdom Radiol (NY). 2017;42(12):2864–73.CrossRef
17.
Zurück zum Zitat Millonig G, Reimann FM, Friedrich S, Fonouni H, Mehrabi A, Buchler MW, et al. Extrahepatic cholestasis increases liver stiffness (FibroScan) irrespective of fibrosis. Hepatology. 2008;48(5):1718–23.CrossRef Millonig G, Reimann FM, Friedrich S, Fonouni H, Mehrabi A, Buchler MW, et al. Extrahepatic cholestasis increases liver stiffness (FibroScan) irrespective of fibrosis. Hepatology. 2008;48(5):1718–23.CrossRef
18.
Zurück zum Zitat Coco B, Oliveri F, Maina AM, Ciccorossi P, Sacco R, Colombatto P, et al. Transient elastography: a new surrogate marker of liver fibrosis influenced by major changes of transaminases. J Viral Hepat. 2007;14(5):360–9.CrossRef Coco B, Oliveri F, Maina AM, Ciccorossi P, Sacco R, Colombatto P, et al. Transient elastography: a new surrogate marker of liver fibrosis influenced by major changes of transaminases. J Viral Hepat. 2007;14(5):360–9.CrossRef
19.
Zurück zum Zitat Arena U, Vizzutti F, Corti G, Ambu S, Stasi C, Bresci S, et al. Acute viral hepatitis increases liver stiffness values measured by transient elastography. Hepatology. 2008;47(2):380–4.CrossRef Arena U, Vizzutti F, Corti G, Ambu S, Stasi C, Bresci S, et al. Acute viral hepatitis increases liver stiffness values measured by transient elastography. Hepatology. 2008;47(2):380–4.CrossRef
20.
Zurück zum Zitat Kellner P, Anadol E, Huneburg R, Hundt F, Bos D, Klein B, et al. The effect of hemodialysis on liver stiffness measurement: a single-center series. Eur J Gastroenterol Hepatol. 2013;25(3):368–72.CrossRef Kellner P, Anadol E, Huneburg R, Hundt F, Bos D, Klein B, et al. The effect of hemodialysis on liver stiffness measurement: a single-center series. Eur J Gastroenterol Hepatol. 2013;25(3):368–72.CrossRef
21.
Zurück zum Zitat Khunpakdee N, Jayanama K, Kaewdoung P, Promson K, Rattanasiri S, Warodomwichit D, et al. Transient elastography in end-stage renal disease patients on hemodialysis: the effect of net fluid withdrawal. Blood Purif. 2015;40(3):256–9.CrossRef Khunpakdee N, Jayanama K, Kaewdoung P, Promson K, Rattanasiri S, Warodomwichit D, et al. Transient elastography in end-stage renal disease patients on hemodialysis: the effect of net fluid withdrawal. Blood Purif. 2015;40(3):256–9.CrossRef
22.
Zurück zum Zitat Taneja S, Borkakoty A, Rathi S, Kumar V, Duseja A, Dhiman RK, et al. Assessment of liver fibrosis by transient elastography should be done after hemodialysis in end stage renal disease patients with liver disease. Dig Dis Sci. 2017;62(11):3186–92.CrossRef Taneja S, Borkakoty A, Rathi S, Kumar V, Duseja A, Dhiman RK, et al. Assessment of liver fibrosis by transient elastography should be done after hemodialysis in end stage renal disease patients with liver disease. Dig Dis Sci. 2017;62(11):3186–92.CrossRef
23.
Zurück zum Zitat Colli A, Pozzoni P, Berzuini A, Gerosa A, Canovi C, Molteni EE, et al. Decompensated chronic heart failure: increased liver stiffness measured by means of transient elastography. Radiology. 2010;257(3):872–8.CrossRef Colli A, Pozzoni P, Berzuini A, Gerosa A, Canovi C, Molteni EE, et al. Decompensated chronic heart failure: increased liver stiffness measured by means of transient elastography. Radiology. 2010;257(3):872–8.CrossRef
24.
Zurück zum Zitat Giallourakis CC, Rosenberg PM, Friedman LS. The liver in heart failure. Clin Liver Dis. 2002;6(4):947–67.CrossRef Giallourakis CC, Rosenberg PM, Friedman LS. The liver in heart failure. Clin Liver Dis. 2002;6(4):947–67.CrossRef
25.
Zurück zum Zitat Piecha F, Peccerella T, Bruckner T, Seitz HK, Rausch V, Mueller S. Arterial pressure suffices to increase liver stiffness. Am J Physiol Gastrointest Liver Physiol. 2016;311(5):G945–G53.CrossRef Piecha F, Peccerella T, Bruckner T, Seitz HK, Rausch V, Mueller S. Arterial pressure suffices to increase liver stiffness. Am J Physiol Gastrointest Liver Physiol. 2016;311(5):G945–G53.CrossRef
26.
Zurück zum Zitat Eipel C, Abshagen K, Vollmar B. Regulation of hepatic blood flow: the hepatic arterial buffer response revisited. World J Gastroenterol. 2010;16(48):6046–57.CrossRef Eipel C, Abshagen K, Vollmar B. Regulation of hepatic blood flow: the hepatic arterial buffer response revisited. World J Gastroenterol. 2010;16(48):6046–57.CrossRef
27.
Zurück zum Zitat Lee H, Ainechi S, Singh M, Ells PF, Sheehan CE, Lin J. Histological spectrum of idiopathic noncirrhotic portal hypertension in liver biopsies from dialysis patients. Int J Surg Pathol. 2015;23(6):439–46.CrossRef Lee H, Ainechi S, Singh M, Ells PF, Sheehan CE, Lin J. Histological spectrum of idiopathic noncirrhotic portal hypertension in liver biopsies from dialysis patients. Int J Surg Pathol. 2015;23(6):439–46.CrossRef
Metadaten
Titel
Impact of hemodialysis on liver stiffness measured with real-time two-dimensional shear wave elastography
verfasst von
Danijela Zjacic Puljiz
Antonio Mestrovic
Ivan Zaja
Ante Tonkic, MD, PhD
Ivica Grgurevic
Darko Duplancic
Ivana Kristina Delic Jukic
Dragan Ljutic
Zeljko Puljiz
Publikationsdatum
28.11.2019
Verlag
Springer Vienna
Erschienen in
Wiener klinische Wochenschrift / Ausgabe 3-4/2021
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI
https://doi.org/10.1007/s00508-019-01577-w

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