Left ventricular twist before and after haemodialysis: an analysis using speckle-tracking echocardiography.

BACKGROUND: The most commonly used parameter of cardiac function in the chronic kidney disease (CKD) patient is ejection fraction (EF), using transthoracic echocardiography (TTE). EF is a highly load-dependent measurement, which varies considerably in CKD patients undergoing haemodialysis. The aim of this pilot study was to evaluate a novel measure of myocardial function, left ventricular twist, which is defined as the 'wringing action of the heart', using speckletracking echocardiography in CKD patients before and after haemodialysis. METHODS: Twenty-six patients were recruited from the Chris Hani Baragwanath Hospital haemodialysis unit. TTE was performed according to a detailed standardised protocol before and after a single haemodialysis session. Echocardiography was also performed on 26 age- and gendermatched healthy subjects. RESULTS: The mean age of the control versus CKD group was 44 ± 11.4 and 43.4 ± 12.2 years, respectively; 46% were male. Apical rotation was diminished in CKD patients compared to controls (4.83 ± 2.3 vs 6.31 ± 1.6 °; p = 0.01) despite no difference in EF (61.7 ± 6.2 vs 58.8 ± 13; p = 0.68). There were no differences in the components of twist: apical rotation, basal rotation and net twist before and after dialysis, despite an increase in EF (58.8 ± 13.7 vs 61.2 ± 13.6; p = 0.02) following dialysis. CONCLUSION: Unlike EF, the components of twist are relatively independent of changes in haemodynamic load seen during dialysis. The decrease in apical rotation may represent an early marker of cardiac pathology in the late-stage CKD patient.

Sirolimus-induced lymphoedema.

Sirolimus is an inhibitor of the mammalian target of rapamycin (mTOR), used as an immunosuppressant for solid-organ transplant recipients and patients with autoimmune disorders. We report a case of lymphoedema, a rare complication of sirolimus, and discuss the mechanism of drug action, the adverse effects and the challenges of treating a kidney transplant recipient with this complication in a resource-limited environment. Lymphoedema is a rare complication of sirolimus, and the mechanisms are not completely understood; however, early recognition can prevent permanent disfiguration. This case highlights the need for early recognition of adverse drug effects and further research into their pathophysiology and management.