Cardiac Dysfunction in Patients on Maintenance Hemodialysis

Analysis of Left-Ventricular Changes Associated with Chronic Hemodialysis

“…The presence of increased preload due to anemia and the arteriovenous fistula magnifies this effect. We interpret these findings as indicative for the development of a diastolic LV heart malfunction due to a decrease in compliance going along with a growing left atrial distension as previously described by our group [15].…”

“…Comparing a group of ESRD patients to healthy con trols and nonrenal patients with idiopathic dilated card iomyopathy, we previously described the cardiac altera tions in ESRD patients as secondary hypertrophic card iomyopathy [15]. In 131 patients on maintenance hemodi alysis studied with echocardiography, left-ventricular (LV) hypertrophy was the most predominant finding [15].…”

“…In 131 patients on maintenance hemodi alysis studied with echocardiography, left-ventricular (LV) hypertrophy was the most predominant finding [15]. The prevalence of LV hypertrophy was not associated with the degree of renal anemia, mean arterial blood pressure, immunoreactive parathyroid hormone concen tration or interdialytic weight gain, but was related to the total time on dialysis.…”

Short-Term Dialysis - Long-Term Complications

“…Thus, in dialysis patients LV end-dia stolic pressure under resting conditions is elevated to 12-23 mm Hg [19,20,27,28]. Evidence, that diminished compliance dur ing diastole is an integral part of hypertro phic cardiomyopathy in dialysis patients and not necessarily an expression of hyperhydra tion, is given in figure 4, which depicts pres sure-volume loops throughout the cardiac circles of 29 patients on MHD [for a descrip tion of the methodology, see ref .…”

“…However, arterial hypotension is often present before dialysis and rapidity of fluid removal is therefore limited. Furthermore, coronary artery disease -confirmed by angi ography in approximately 30-40% of all pa tients on MHD [16,19,28] -exhibits the major cause of LV dilatation; although those patients will profit by volume loss [31], hy potension is an important limiting factor in compromised coronary perfusion. In addi tion, reduction of'dry weight' (preload) is an important goal in patients with coronary ar tery disease and can be achieved by slow ultrafiltration with less symptoms as com pared to rapid volume loss.…”